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Please submit to: Active Benefit Services, LLC. 2905 Lucerne Dr., S.E., Suite 555 Grand Rapids, Ml 49546 Claims. 8668071097 Fax. 6167874590 MEDICAL CLAIM PATIENT INFORMATION Patient Name Gender If
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To fill out the "Please Submit to Activa" form, follow these steps:

01
Start by obtaining the form from the designated source, such as Activa's website or a physical copy from their office.
02
Read the instructions carefully to understand the purpose and requirements of the form.
03
Begin filling out the form by entering your personal information, such as your full name, contact details, and any other requested identifying information.
04
Provide any additional information requested on the form, such as your account number, membership details, or specific reference numbers.
05
Double-check all the information you have entered to ensure accuracy and completeness. It is crucial to provide correct and up-to-date information to avoid any potential issues or delays.
06
If there are any supporting documents required, gather them and attach them to the form according to the provided instructions. This may include identification documents, proof of residency, or any other necessary paperwork.
07
Once you have completed filling out the form and attaching any required documents, review everything again to make sure you have not missed anything.
08
Submit the filled-out form and any attachments according to the designated submission method. This could involve mailing the form, submitting it online through Activa's website, or directly submitting it to their office.
09
Keep a copy of the filled-out form and any related documents for your records.
10
Wait for a confirmation of receipt from Activa and ensure you follow up, if required.
Regarding who needs to submit the form "Please Submit to Activa," it would be required by individuals or entities who have a relationship with Activa and are requested to provide specific information, documents, or applications as requested by Activa. This could include customers, members, applicants, or any other person or organization engaged in business or interactions with Activa.
Please note that the specific requirements and purpose of the "Please Submit to Activa" form may vary depending on Activa's policies, procedures, and context. It is always recommended to carefully read the instructions provided with the form or consult Activa directly for any clarification or guidance.
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Please submit to activa is a form or document that needs to be submitted to the company's department responsible for activating certain services or processes.
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