Loading
Get Geisinger Health Plan Request For Claim Reconsideration 2014
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Geisinger Health Plan Request for Claim Reconsideration online
This guide will help you navigate the process of completing the Geisinger Health Plan Request for Claim Reconsideration online. By following these detailed steps, you can ensure that your claim is properly submitted for reconsideration.
Follow the steps to accurately complete your claim reconsideration request.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the member information section. Provide your health plan ID, complete name, and birthdate. Ensure all fields marked with an asterisk are filled in as they are required.
- Enter your address and the contact information for a caregiver or alternate contact, if applicable. Include current phone numbers for each listed individual.
- Complete the other insurance information section. If you have additional insurance coverage through Workman's Compensation or auto insurance, include the company name and policy number.
- Fill out the diagnosis information. Enter at least one ICD-9 code along with a corresponding description. If necessary, use additional codes and descriptions.
- In the requested information area, provide details for the ordering physician and primary care physician, including their names and contact information.
- List the requested equipment and anticipated delivery date in the specified sections. Make sure to provide all necessary details regarding the equipment.
- Specify the HCPCS/modifier codes along with a description and quantity for the vendor request section.
- Review the entire form for completeness, ensuring that all required fields are filled accurately. Incomplete forms will be returned unprocessed.
- Once all sections are completed, you can save changes, download, print, or share the form as needed.
Complete your Geisinger Health Plan Request for Claim Reconsideration online today!
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
MVP Health Plan Inc. is a subsidiary of MVP Health Care, Inc. This organization is focused on providing quality health insurance plans with a member-centric approach. Should members of MVP have any issues, they can utilize the Geisinger Health Plan Request for Claim Reconsideration to efficiently address billing disputes.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.