Anthem BCBS 490773 2005 free printable template

EMPLOYEE HEALTH ENROLLMENT APPLICATION Group Size 15 Please complete in ink and return to your employer. Use extra sheets of paper if necessary. The Primary Care Physician PCP listings of Anthem and its affiliated HMO companies can be obtained through www. CHECK COMPANY S AND WRITE IN PRODUCT THAT APPLIES. APPLICATION COMPLETED FOR Anthem Blue Cross and Blue Shield HealthKeepers Inc. Peninsula Health Care Inc. HMO Priority Health Care Inc. HMO Coverage Option If your employer/group offers...

How to fill out Anformm BCBS 490773

How to fill out Anthem BCBS 490773

1. Obtain a copy of Anthem BCBS 490773 form.
2. Read the instructions carefully at the top of the form.
3. Fill out personal information: name, address, date of birth, and policy number.
4. Provide any necessary medical information related to the claim or service.
5. If applicable, include details of the healthcare provider or service rendered.
6. Check for any required signatures and sign the form where indicated.
7. Review the entire form for accuracy and completeness.
8. Submit the completed form to the address provided on the form.

Who needs Anthem BCBS 490773?

1. Individuals or families covered by Anthem Blue Cross Blue Shield insurance.
2. People who need to file a claim or request services related to their health coverage.
3. Those seeking reimbursement for medical expenses.

Instructions and Help about Anformm BCBS 490773

This video will walk you through the anthem blue cross application we would recommend that you positive step to make it easier to follow along we still encourage everyone to call member services on the toll-free numbers shown on your papers so that one of our service representatives can take you through the application one-on-one an application is completely filled out with salesman processing and your policy will be issued faster please keep in mind the following this video for completion will take longer than a one-on-one session simply because of the more detailed explanations and deposits to the video remember you can pause or backup this video at any time okay let's go ahead and get started if you open up the blue folder with all the papers inside you will find two applications held by paper clips on the left-hand side each one will have a cover sheet that will show the various marks that appear on the pages of the application that will need your attention, so you should have two application stacks that look just like this so take one out and the first thing we're going to do is to remove the bottom three pages juicer marked client copy so just count off the bottom three take those out and set them aside those will not be sent into membership services those you will keep for your own records now remove the paper clip and the top cover sheet from one of the application packages than let's start with paper that says Anthem Blue Cross medicare supplement California at the top that should be the very first sheet please try to locate a black pan to complete the papers that would as it will produce a better copy when we receive it blue can be used if you own a black so don't run out by a black pin it's perfectly okay I might mention here that all the original papers will be returned to you with your policy and ID card after the plan is issue let me point out that each page of the application has a number at the bottom right-hand corner that will signify numbers one through ten if you look down at the very bottom of the right-hand corner of the top paper it will say P 1 of 10 which simply means page 1 of 10 pages so go ahead and complete section a that is your personal information, and you probably know this off the top of your head when you're finished go to Section B that is the information that will appear under red white and blue Medicare card please locate your Medicare card and just copy the information on to this part of the application the hospital Part A and medical part be effective dates are the month and the year you first became covered under Medicare not the date that you want this policy to the issue now quick question is someone who lives in your house either covered under an anthem blue cross plan or applying it for one at the same time if you are this could be a relative to lose with you, or it could be your spouse if the answer is yes please write their information in this section and each of you will receive a five percent...

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What is Anthem BCBS 490773?

Anthem BCBS 490773 is a specific form or document associated with Anthem Blue Cross Blue Shield, typically related to health insurance claims or benefits.

Who is required to file Anthem BCBS 490773?

Providers, healthcare facilities, and insured individuals who are seeking reimbursement or benefits from Anthem Blue Cross Blue Shield are required to file Anthem BCBS 490773.

How to fill out Anthem BCBS 490773?

To fill out Anthem BCBS 490773, you need to provide accurate patient information, details about the medical services rendered, associated billing codes, and any other relevant information as specified in the form instructions.

What is the purpose of Anthem BCBS 490773?

The purpose of Anthem BCBS 490773 is to process medical claims and to facilitate the reimbursement of healthcare expenses incurred by insured individuals.

What information must be reported on Anthem BCBS 490773?

Information that must be reported on Anthem BCBS 490773 includes patient demographics, dates of service, type of service provided, billing codes, provider information, and any additional notes required by Anthem BCBS.