Get the free NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDI...

This form is for non-contract providers requesting a review of a service provided to a BCBSNC Medicare Advantage member that was denied.

How to fill out non-contract provider post service

How to fill out NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM

1. Obtain the NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM from the Blue Medicare website or your local Blue Medicare office.
2. Fill in the patient's information at the top of the form, including name, date of birth, and member ID number.
3. Provide details about the service in question, including the date of service, type of service, and any relevant codes.
4. Clearly state the reason for the appeal, explaining why you believe the service should be covered.
5. Include any supporting documents, such as medical records or previous correspondence related to the appeal.
6. Sign and date the form to certify the information provided is accurate.
7. Submit the completed form and any attachments to the designated address provided on the form.

Who needs NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

1. Individuals who have received services from a non-contract provider and believe the denial of coverage by Blue Medicare HMO or PPO is unjust.
2. Healthcare providers on behalf of patients who wish to appeal a decision regarding coverage of services.
3. Patients or family members seeking clarification or a review of a service denial under their Blue Medicare plan.

For pdfFiller’s FAQs

What is NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

The NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM for Blue Medicare HMO and PPO is a document used by non-contracted healthcare providers to appeal payment decisions made by Blue Medicare plans regarding services rendered to members.

Who is required to file NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

Non-contracted providers who have provided services to members of Blue Medicare HMO or PPO plans and believe their claims have been denied or incorrectly paid are required to file this appeal form.

How to fill out NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

To fill out the NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM, providers should complete all required fields, including patient information, service details, claim number, and a clear explanation of the reason for the appeal, and submit it to the appropriate Blue Medicare address.

What is the purpose of NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

The purpose of the NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM is to allow non-contracted healthcare providers an opportunity to contest the denial of payment or request a review of the payment amount for services provided to Blue Medicare members.

What information must be reported on NON-CONTRACT PROVIDER POST SERVICE APPEAL FORM FOR BLUE MEDICARE HMOSM AND BLUE MEDICARE PPOSM?

The information that must be reported includes provider details, patient information, claim number, date of service, description of services rendered, reason for appeal, and any supporting documentation that justifies the appeal.