AL Blue Cross Blue Shield PRO-118-D 2007-2025 free printable template

Home Health Services REQUEST FOR CERTIFICATION* An Independent Licensee of the Blue Cross and Blue Shield Association. Home Health Services prior to start of care * Please verify Contract Benefit

How to fill out AL Blue Cross Blue Shield PRO-118-D

How to fill out AL Blue Cross Blue Shield PRO-118-D

1. Begin with the patient’s full name in the designated field.
2. Enter the patient's date of birth in the specified format.
3. Provide the patient's address, including city, state, and ZIP code.
4. Fill in the policy number assigned by Blue Cross Blue Shield.
5. Indicate the type of claim (medical, dental, etc.) in the appropriate section.
6. List all services provided, including dates and codes if applicable.
7. Attach any necessary supporting documentation, such as bills or medical records.
8. Review the completed form for accuracy and completeness.
9. Sign and date the form where indicated.
10. Submit the form according to the directions provided, either via mail or electronically.

Who needs AL Blue Cross Blue Shield PRO-118-D?

1. Individuals who have received medical or dental services covered by Blue Cross Blue Shield.
2. Providers or healthcare professionals seeking reimbursement for services rendered.
3. Patients who need to file a claim for covered healthcare expenses.
4. Anyone who is required to submit claims for insurance coverage claims with their policy.

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What is AL Blue Cross Blue Shield PRO-118-D?

AL Blue Cross Blue Shield PRO-118-D is a form used by healthcare providers in Alabama for reporting and billing medical services to Blue Cross Blue Shield of Alabama.

Who is required to file AL Blue Cross Blue Shield PRO-118-D?

Healthcare providers and facilities that render services covered by Blue Cross Blue Shield of Alabama are required to file AL Blue Cross Blue Shield PRO-118-D.

How to fill out AL Blue Cross Blue Shield PRO-118-D?

To fill out AL Blue Cross Blue Shield PRO-118-D, providers should include patient information, service details, diagnosis codes, billing information, and any additional documentation required by the insurance company.

What is the purpose of AL Blue Cross Blue Shield PRO-118-D?

The purpose of AL Blue Cross Blue Shield PRO-118-D is to facilitate the claims process by providing necessary information to Blue Cross Blue Shield of Alabama for accurate billing and reimbursement.

What information must be reported on AL Blue Cross Blue Shield PRO-118-D?

Information that must be reported on AL Blue Cross Blue Shield PRO-118-D includes patient demographics, provider details, specific services rendered, diagnosis codes, dates of service, and billing amounts.