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Get Regence Pd019 2012
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How to fill out the Regence PD019 online
Filling out the Regence PD019 form is essential for submitting your health insurance reimbursement claims. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to fill out the Regence PD019 form online.
- Press the ‘Get Form’ button to obtain the Regence PD019 form and open it in your online editor.
- Complete the member information section by providing the patient's name, date of birth, sex, and their relationship to the policyholder. Also, include the policyholder's name, address, and telephone number.
- In the other insurance information section, answer whether any family members covered by this policy have other medical, dental, prescription, or vision coverage. If yes, specify the details.
- Tape original receipts in the designated boxes on the form. Ensure that cash register receipts are not included as they are not accepted. Retain copies of all receipts for your records.
- Indicate the nature of the illness or injury in the space provided, and record the doctor’s name if it is not on the receipt.
- Sign and date the form where indicated and prepare to mail it to the specified address: Regence BlueShield, PO Box 21267, Seattle, WA 98111-3267.
- After completing the form, save your changes, and consider downloading or printing a copy for your records before mailing.
Complete your Regence PD019 claims form online today to ensure timely processing of your reimbursement.
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Blue Cross Blue Shield is owned by a collective of independent, community-based health insurance companies in the United States. Each regional company, like Regence, operates under the Blue Cross Blue Shield Association while maintaining its governance. By opting for Regence PD019, you access services from a trusted organization that upholds the principles of Blue Cross Blue Shield.
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