Blue cross blue shield federal claim form
BLUE CROSS AND BLUE SHIELD
Feb 15, 2011 · An Independent Licensee of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. ® Registered marks Blue Cross and Blue Shield …
[DOC File]REQUEST FOR SIGN-ON AND CLIENT ID
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That it will retain all original source documentation and medical records pertaining to any such particular Blue Cross claim for period of at least 6 years, 3 months after the bill is paid. That it will affix the Blue Cross-assigned unique identifier number of the provider on each claim electronically transmitted to Blue Cross.
[DOC File]Corrected Claim - Standard Cover Sheet - Premera Blue Cross
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Premera Blue Cross Blue Shield of Alaska is an Independent Licensee of the Blue Cross Blue Shield Association. Corrected Claim – Standard Cover Sheet (A claim that has been processed and the claim needs to be corrected.) 013063 (07-2018) Premera Blue Cross Blue Shield of Alaska is an Independent Licensee of the Blue Cross Blue Shield …
[DOC File]Provider Appeals Submission FEP - Premera Blue Cross
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Premera Blue Cross FEP. P.O. Box 33932. Seattle WA 98133. Fax: 877-239-3390. This template may be updated periodically; do not print a large supply because it may become outdated. Mail or fax the completed form and supporting documentation to: Attn: Provider Appeals. Premera Blue Cross …
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