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  • Premera Bcbs Form 014664 2005

Get Premera Bcbs Form 014664 2005-2025

Practitioner Name: , (Last Name) (First Name) (MI ) Social Security #: DOB: Male (Credential based on licensure) Female State License #: State: Additional State License #: State: DSHS #: UPIN #: DEA #: Medicare #: (if applicable) Individual NPI #:.

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How to fill out the Premera BCBS Form 014664 online

This guide provides clear and supportive instructions on how to fill out the Premera BCBS Form 014664 online. Follow these steps to ensure accurate completion for efficient processing.

Follow the steps to successfully complete the form online.

  1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
  2. Begin by entering the practitioner's name in the designated fields: first name, middle initial, and last name.
  3. Provide the practitioner's Social Security number and date of birth, ensuring to select their gender.
  4. Fill in the state license number and specify the state of licensure. If applicable, include any additional state licenses.
  5. Include the DSHS number, UPIN number, DEA number, and Medicare number if relevant.
  6. Enter the individual NPI number and any foreign languages spoken by the practitioner.
  7. List the primary specialty and check the appropriate board status. Also, ensure to include any secondary specialty and corresponding board status.
  8. Fill in the clinic or group name along with the group NPI number and the start date at the clinic or group.
  9. Complete the primary practice address with street, city, state, and zip code.
  10. Indicate the services available, such as wheelchair accessibility and interpretive services.
  11. Provide the tax ID number, office hours, and contact phone numbers.
  12. Complete the pay-to address and mailing address for correspondence.
  13. Enter the email addresses for both the clinic and the practitioner.
  14. If there are multiple practice locations, attach a list with the required information for each location.
  15. Finally, document who completed the form and the date of completion.
  16. After filling out all sections, you may save your changes, download, print, or share the completed form.

Complete your Premera BCBS Form 014664 online for a smooth submission process.

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No, Premera Blue Cross is not leaving Washington state. They remain committed to providing quality health insurance options to residents. If you're interested in navigating your options or need the Premera BCBS Form 014664, our platform can guide you in finding the appropriate forms and resources.

In Washington state, Blue Cross Blue Shield operates primarily under the name Premera Blue Cross. This identification reflects their commitment to serving the local community while maintaining the larger BCBS network's benefits. For any related queries or forms like the Premera BCBS Form 014664, please visit our site for comprehensive resources.

No, Premera Blue Cross is not leaving Washington state. They continue to offer a range of health insurance products to residents confidently. If you're looking for forms such as the Premera BCBS Form 014664, you can find them readily available through our platform, ensuring you have access to what you need.

Premera Blue Cross primarily serves Washington and Alaska, providing health insurance options tailored to the needs of residents in these regions. If you're specifically looking for the Premera BCBS Form 014664, it's important to note that this form is relevant to their offerings in Washington. You can rely on uslegalforms for further assistance with any documentation related to your insurance needs.

Premera Blue Cross and Blue Cross Blue Shield are closely related, but they are not identical entities. Premera Blue Cross is a regional affiliate of the national Blue Cross Blue Shield Association, offering unique plans and coverage tailored specifically for its members. When you use the Premera BCBS Form 014664, you engage directly with the services and policies specific to Premera while still benefiting from the extensive BCBS network.

Filling out the medical authorization form, such as the Premera BCBS Form 014664, is straightforward if you follow a few key steps. Start by providing your personal information, including your name, address, and insurance details. Next, clearly specify the type of medical information you authorize to be released and to whom it should be sent. Finally, ensure that you sign and date the form to validate your authorization.

Premera is not the same as Blue Cross Blue Shield, but it is an independent licensee of the Blue Cross Blue Shield Association. Essentially, Premera operates under the Blue Cross Blue Shield brand, offering similar health insurance products tailored to its members in the Pacific Northwest. This means that you can access benefits through the BCBS network, but your specific plan and services may vary based on Premera’s offerings.

Yes, Premera Blue Cross operates under the Blue Cross Blue Shield umbrella but is a distinct entity providing insurance services in specific regions. While both share similar principles and are part of the same network, their coverage options and customer service experiences may differ. For specific queries regarding coverage, the Premera BCBS Form 014664 can be very helpful to clarify these distinctions.

No, prior authorization is not always necessary for every medical service. Many routine and emergency services are exempt from this requirement. However, for specific treatments or specialty medications, prior authorization may be essential. Always check your coverage details using the Premera BCBS Form 014664 for more information on what approvals are needed.

Typically, certain preventive services, routine check-ups, and emergency care do not require prior authorization. However, this can vary based on specific health plans and services, so it is important to verify with your provider. To understand what services may not require prior authorization under your plan, consult the Premera BCBS Form 014664. This document provides clarity on approvals required for various services.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232