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MEMBER AUTHORIZATION REQUEST FORM ELIGIBILITY AND ENROLLMENT SUPPORT CENTER You may give Benefitfocus.com, Inc., the Eligibility and Enrollment Services vendor for the North Carolina State Health
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What is memberdependent authorization request form?
The memberdependent authorization request form is a form used to request authorization for a dependent to receive specific benefits or services.
Who is required to file memberdependent authorization request form?
Any member who has a dependent that needs authorization for benefits or services must file the memberdependent authorization request form.
How to fill out memberdependent authorization request form?
To fill out the memberdependent authorization request form, the member must provide information about themselves and their dependent, as well as details about the benefits or services being requested.
What is the purpose of memberdependent authorization request form?
The purpose of the memberdependent authorization request form is to ensure that dependents of members receive the necessary authorization for benefits or services.
What information must be reported on memberdependent authorization request form?
The memberdependent authorization request form must include information about the member, the dependent, and the benefits or services being requested.
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