Get the free 1552 PCP Selection Formdoc - sechc

(866× 3359317 FAX TO ENROLLMENT DEPT (617× 8970838 FAXES MUST BE RECEIVED WITHIN 24 HOURS OF THE DATE OF SERVICE IN ORDER FOR CLAIMS TO BE CONSIDERED FOR PAYMENT. PRIMARY CARE PROVIDER SELECTION

How to fill out 1552 pcp selection formdoc

How to Fill Out 1552 PCP Selection Formdoc:

1. Start by opening the 1552 PCP Selection Formdoc on your computer.
2. Fill in your personal information in the designated fields, including your name, address, phone number, and email address.
3. Indicate your preferred PCP (Primary Care Physician) by selecting their name from the list provided or by writing their name in the designated space.
4. If you don't have a preferred PCP, leave the field blank or select the option to be assigned one by your healthcare provider.
5. Provide any additional information requested on the form, such as your health insurance information or any specific medical conditions you may have.
6. Review the completed form for accuracy and make any necessary corrections before submitting it.
7. Once you are satisfied with the information provided, save the form and print a copy for your records.
8. Submit the completed form as instructed by your healthcare provider or insurance company.

Who Needs 1552 PCP Selection Formdoc?

1. Individuals who are enrolling in a new health insurance plan may need to fill out the 1552 PCP Selection Formdoc.
2. Existing policyholders who wish to change their primary care physician may also need to complete this form.
3. People who are unsure about their current primary care physician and want to make a specific selection for their healthcare needs can use this form to indicate their preference.

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