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Get Wellmark S-53260 2017
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How to fill out the Wellmark S-53260 online
Filling out the Wellmark S-53260 form online is essential for registering electronic claims with Wellmark Blue Cross and Blue Shield. This guide provides step-by-step instructions to help users complete the registration process efficiently.
Follow the steps to accurately complete the Wellmark S-53260 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Fill in the submitter name, contact person, title, phone, and fax number in the specified fields of the form. Ensure that all provided information is accurate.
- Enter the submitter address, including Address 1, Address 2 (if necessary), city, state, zip code, and county. Double-check for any typographical errors.
- Indicate whether you have an existing submitter ID by checking 'Yes' or 'No.' If 'Yes,' provide your submitter ID in the designated space.
- Respond to the clearinghouse services question based on your operational capabilities. Mark 'Yes' or 'No' as appropriate.
- Complete the provider information section by filling in the vendor name, provider name, address, city, state, zip code, phone, tax ID, group provider NPI, and individual names and NPI.
- Review the authorization section, ensuring the designated administrator's name and title are correct.
- After completing all the required fields, sign and date the registration form in the signature section at the bottom.
- Submit the completed registration form by faxing it to 800-691-1038 or email it to wellmarkecsolutionsregistration@hpe.com.
- Upon submission, allow approximately 10 business days for processing, and then follow up if you do not receive confirmation regarding your submitter ID or additional provider details.
Begin your online form submission process today to ensure timely registration with Wellmark.
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While Wellmark S-53260 and Blue Cross Blue Shield share commonalities, they are not identical. Wellmark is a specific provider under the broader Blue Cross Blue Shield umbrella, tailored to meet the needs of its market. It's important to examine the distinct benefits and services each offers to find the right fit for you. US Legal Forms can assist in clarifying these details perfectly.
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