Get Canada Green Shield Claim Form For Health Professional Services 2022-2025

Filling out the Canada Green Shield Claim Form For Health Professional Services online is a straightforward process that ensures you can submit your claims swiftly and securely. This guide will walk you through each step, highlighting important components to help you complete the form accurately.

Follow the steps to fill out the form effectively.

1. Click ‘Get Form’ button to access the claim form and open it in the designated editor.
2. In Section 1, provide the patient's information, including their Green Shield number, date of birth, surname, first name, and contact details. Ensure all details are accurate to prevent any delays.
3. Complete the provider information by entering the provider's number, name, phone number, address, and email. Each field must be filled in fully to ensure compliance and contactability.
4. Move to Section 2, the Mandatory Declaration. Indicate whether the patient has any other insurance coverage by answering the questions with 'Yes' or 'No'. If other coverage applies, include relevant dates and case numbers, particularly for motor vehicle or work-related injuries.
5. In Section 3, ensure that this section is thoroughly completed by the provider. Record the treatment received, including the number of hours if applicable, the date of service, whether tax is included, and the charges for each service rendered.
6. Verify all patient diagnoses and sign the form in the space provided to certify accuracy of the information. Include the provider's registration number and type.
7. Proceed to Section 4 to give authorization and consent regarding personal information. Read the consent details carefully and sign to acknowledge the privacy practices of Green Shield Canada.
8. In Section 5, execute the assignment of benefits by having the patient or legal guardian sign, as well as the provider. This authorizes the direct payment to the provider for services rendered.
9. Finally, follow the mailing instructions outlined in Section 6. Ensure all claims are sent within 12 months of the date of service and retain copies for your records before mailing the original documents to the provided address.
10. Once you have completed the form, save changes, download, print, or freely share the form as necessary.

Complete your Canada Green Shield Claim Form for Health Professional Services online today to ensure prompt processing of your claims.