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  • Mn Bcbs X20959 2018

Get Mn Bcbs X20959 2018-2025

Explanation including diagnosis code(s) why member is being referred beyond state guidelines: Name of Clinic/Facility being Referred to: Referred Clinic/Facility Address: Date Span of Referral: Note: Attach medical records that support medical necessity and reason for travel beyond state guidelines. Primary Care Doctor can be Physician, Nurse Practitioner, Clinical Nurse Specialist or Physician Assistant. Please provide the details requested above and return this form by fax to 1-855-933-6992.

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Call (651) 662-5050, 1-800-262-0823. Email.

Payer Name: Highmark Senior Health Company - Pennsylvania.

Provider payer ID is 00562.

Claims are processed through Availity using the payer ID code 00562.

Note: Customer Service: (800) 366-5411.

Call (651) 662-5545 or toll free 1-800-711-9862 (TTY 711), 8 a.m. to 5 p.m. Monday through Friday. Check your plan's Member Handbook for details about your plan. See our directory of statewide resources at minnesotahelp.info - Opens in a new window.

Call (651) 662-5545 or toll free 1-800-711-9862 (TTY 711), 8 a.m. to 5 p.m. Monday through Friday. Check your plan's Member Handbook for details about your plan. See our directory of statewide resources at minnesotahelp.info - Opens in a new window.

(651) 662-5050 or toll free 1-800-262-0823 if you are not eligible for Medicare. (651) 662-9949 or toll free 1-855-579-7658 if you are eligible for Medicare.

The Payer ID or EDI is a unique ID assigned to each insurance company. It allows provider and payer systems to talk to one another to verify eligibility, benefits and submit claims. The payer ID is generally five (5) characters but it may be longer. It may also be alpha, numeric or a combination.

Payer name and ID Provider payer ID is 00562. The payer name for Blue Cross is: BCBSMN BLUE PLUS MEDICAID.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232