Get Cn Msh Non-direct Billing Claim Form 2022-2025

Filling out the CN MSH Non-Direct Billing Claim Form online can simplify the claims process for users. This guide outlines the necessary steps to ensure that all required information is completed accurately and efficiently.

Follow the steps to complete the claim form online.

1. Press the ‘Get Form’ button to access the CN MSH Non-Direct Billing Claim Form and open it in the online editor.
2. Begin with entering the patient information in Part A. Fill in all mandatory fields marked with an asterisk (*), including the member ID, date of birth (DOB), name, gender, nationality, profession, and telephone number.
3. Indicate the type of ID document being used, and provide the document number and its validity period. Ensure all details match the original ID document.
4. Provide the permanent address and the relationship between the patient and the primary insured, selecting the appropriate box to clarify the relationship.
5. Proceed to the payment information section. Clearly fill out the bank account details, selecting either a CNY or non-CNY bank account. Ensure that the name on the account matches the name on the ID/passport.
6. Review the anti-insurance fraud prompt carefully. Acknowledge the legal responsibilities associated with the claim, ensuring understanding of the penalties for false information.
7. Complete the authorization section, allowing the Service Center to access necessary information for processing the claim. Ensure that all signatures are provided where required, especially if the patient is a minor.
8. Once all sections are completed, review the entire form for accuracy and completeness. Make necessary corrections any discrepancies before moving forward.
9. After ensuring that all information is accurate, save the form. You can then choose to download, print, or share the completed claim form as necessary.

Complete your CN MSH Non-Direct Billing Claim Form online today to ensure timely processing of your claim.