Get Provider Refund Return Form - Blue Cross And Blue Shield Of North ...

Completing the Provider Refund Return Form for Blue Cross And Blue Shield Of North Carolina is an essential step in processing overpayments. This guide provides you with clear, step-by-step instructions to help ensure your information is accurately submitted online.

Follow the steps to complete your Provider Refund Return Form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, check the appropriate box to identify the plan category: Blue Cross and Blue Shield of NC plan, Federal Employee Program, North Carolina Teachers & State Employees’ Health Plan, or another specified health plan.
3. Provide the subscriber's name and subscriber ID, ensuring that all information is accurate to facilitate the refund process.
4. Enter the patient's name and the date(s) of service relevant to the overpayment.
5. Complete the provider name and provider number fields. If the provider is located outside North Carolina, input the IRS Tax-ID number.
6. Specify the amount of refund you are requesting to return.
7. Check the reason(s) for the refund, providing supporting documents as required, such as EOBs or corrected claims.
8. Include any additional comments that may assist in processing the refund request.
9. List the contact person’s name and phone number for follow-up questions.
10. Once all fields are completed, save any changes made to the form, and prepare to download, print, or share the completed document as necessary.

Start filling out your Provider Refund Return Form online today to ensure a smooth and efficient refund process.