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  • Medex Subscriber Claim Form

Get Medex Subscriber Claim Form

Medex Subscriber Claim Form Medex Identification Number Important Take this number from your Medex ID Card. NOTE This should not be used to submit a drug claim if you are a direct-pay member. Instead please fill out a separate MEDEX DRUG CLAIM FORM. Have you listed your Medex Identification Number in the space provided Have you attached original itemized bills for your pharmacy and out-of-country claims forms you may have received previously for.

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Certification Related content

Subscriber Claim Form - Blue Cross Blue Shield of...
Instructions for Submitting Claims. 1. Submit a claim only when you are billed for...
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Subscriber Claim Form - Blue Cross Blue Shield of...
Instructions for Submitting Claims. 1. Submit a claim only when you are billed for...
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The person who pays for health insurance premiums or whose employment is the basis for membership in the insurance plan. For example, if you have health insurance through your spouse's health insurance plan, he or she is the primary subscriber.

A claim form is a standard printed document used for submitting a claim. Under normal circumstances, reimbursement will take place within ten days of receipt and approval of claim form and all required documents.

Mailing Address (claims and correspondence): Blue Benefit Administrators of Massachusetts. PO BOX 55917. Boston, MA 02205-5917.

This plan supplements Medicare coverage for inpatient and outpatient care, including prescription drugs through the Blue MedicareRxSM.

Click Blue Cross Blue Shield's Payer ID, SB700.

Call 1-800-200-4255(TTY: 711).

Expenses that are not covered by Medicare are often referred to as “gap.” Medicare supplement, “Medigap” plans, such as Medex help to fill in these coverage gaps. It helps you pay Medicare's deductible and co-insurance costs, and covers certain services Medicare doesn't.

Submit the claim to us within 90 days from the other payer's rejection date The claim was submitted to the other insurer within 90 days of the date of service or discharge.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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