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Get ID Blue Cross Form 5-123 2013-2024

Ment will notify S you of their decision by secure email, mail, phone or fax. Authorization period may not exceed three months without review of medical records. If medical necessity justifies special handling, please include an explanation. •  lease fax this completed form, along with the medical records documenting the clinical indications or medical necessity to the appropriate fax number listed P below. For questions regarding this form, please call 208-331-7535 or 800-743-1871. •  lea.

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