Get Nv Anthem C1001 2012-2025

The NV Anthem C1001 is an essential document for individuals seeking reimbursement for prescription drugs. Filling it out correctly ensures timely processing and avoids delays with your claims.

Follow the steps to successfully complete the NV Anthem C1001 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your member/subscriber information. Refer to your prescription drug ID card to fill in the necessary details such as health plan name, member name, street address, city, state, and ZIP code.
3. For patient information, fill out the patient's full name, date of birth, sex, and relationship to the plan member.
4. In the claim receipts section, tape the receipts or itemized bills on the back of the form. Ensure receipts include all required details like pharmacy name, prescription filled date, doctor name, NDC number, drug name and strength, quantity, prescription number, and the amount paid.
5. In the pharmacy information section, provide the name, street address, city, state, ZIP, and telephone number of the pharmacy. Indicate whether it is an on-site nursing home pharmacy.
6. Complete the acknowledgment area by signing and dating the form. Note that this certifies the accuracy of the information provided.
7. After completing the NV Anthem C1001, review the form for completeness. Save any changes, download, print, or share the form as needed. Ensure it is submitted within the required timeframe.

Complete your reimbursement claim efficiently by filling out the NV Anthem C1001 online today.