Highmark ENR-163 2012 free printable template
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For Changes: High mark P.O. Box 890172 Camp Hill, PA 17089-0172 MEMBER CHANGE FORM COMPLETE THIS APPLICATION IN ITS ENTIRETY IN BLUE OR BLACK INK. DO NOT USE PENCIL OR HIGHLIGHTER. EMPLOYEE APPLICATION
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How to fill out Highmark ENR-163
How to fill out Highmark ENR-163
01
Obtain the Highmark ENR-163 form from the Highmark website or your local office.
02
Fill out the member identification number at the top of the form.
03
Provide the member's personal information, including name, date of birth, and address.
04
Indicate the type of coverage being applied for by checking the appropriate box.
05
Complete any additional sections as required, including dependent information if applicable.
06
Review the completed form for accuracy and ensure all required fields are filled.
07
Sign and date the form in the designated section.
08
Submit the form via mail or online, following the instructions provided by Highmark.
Who needs Highmark ENR-163?
01
Individuals seeking to enroll in a new Highmark health plan.
02
Current Highmark members wishing to change their coverage options.
03
Dependents of Highmark members needing to enroll under a family plan.
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People Also Ask about
How do I contact Highmark BCBS Delaware?
Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans.
What is the phone number for BCBS PA Highmark Blue Shield provider?
Provider Service Center at: Western Region: 1-800-547-3627, option 2. Central Region: 1-800-345-3805, option 3. Hours are from 9:00 a.m. to 4:30 p.m., Monday through Friday.
What is timely filing for Highmark BCBS of Delaware?
All claims including EPSDT claims must be received within 120 days of the date of service or 60 days from the date of remittance from a primary payer.
How do I recover my Highmark online access?
Please call the help desk at 1-877-298-3918 to retrieve your username or password.
What is the phone number for Highmark bcbs pa provider credentialing?
Request a Call to talk to a Highmark licensed representative about our non-Medicare plans or to enroll. Not a Highmark member? Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans.
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What is Highmark ENR-163?
Highmark ENR-163 is a specific form used for reporting enrollment and related information to Highmark, typically concerning health insurance coverage.
Who is required to file Highmark ENR-163?
Entities that manage health insurance plans, such as insurance carriers or employers providing health benefits, are required to file Highmark ENR-163.
How to fill out Highmark ENR-163?
To fill out Highmark ENR-163, follow the instructions provided with the form, ensuring all required fields are completed accurately with the necessary enrollment information.
What is the purpose of Highmark ENR-163?
The purpose of Highmark ENR-163 is to collect and report enrollment data to Highmark to aid in the management and oversight of health insurance programs.
What information must be reported on Highmark ENR-163?
Information that must be reported on Highmark ENR-163 includes details about the insured individuals such as names, dates of birth, coverage details, and other demographic data as required by Highmark.
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