Highmark ENR-163 2014 free printable template
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MEMBER CHANGE FORM COMPLETE THIS APPLICATION IN ITS ENTIRETY IN BLUE OR BLACK INK. DO NOT USE PENCIL OR HIGHLIGHTER. EMPLOYEE/CONTRACT HOLDER INFORMATION Effective Date Employer/Group Name REASON
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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 healthcare provider.
02
Fill in your personal information, including your name, address, and contact details.
03
Provide your member ID number as it appears on your insurance card.
04
Indicate the type of coverage you are requesting (e.g., individual or family coverage).
05
Complete the section on dependents, providing their names and relationship to you.
06
Review the terms and conditions associated with the form and sign where indicated.
07
Submit the completed form to the appropriate Highmark processing address or as instructed.
Who needs Highmark ENR-163?
01
Anyone looking to enroll or update their information in a Highmark health insurance plan.
02
Individuals or families seeking new coverage options under Highmark healthcare policies.
03
Current Highmark members who need to add dependents or make changes to their existing enrollment.
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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 certain healthcare-related information to Highmark, a health insurance provider.
Who is required to file Highmark ENR-163?
Entities such as healthcare providers, facilities, or organizations that have dealings with Highmark and fall under specific reporting requirements must file Highmark ENR-163.
How to fill out Highmark ENR-163?
To fill out Highmark ENR-163, users should gather the required information, follow the instructions provided with the form, and ensure all mandatory fields are accurately completed.
What is the purpose of Highmark ENR-163?
The purpose of Highmark ENR-163 is to collect necessary data for claims processing, auditing, and compliance purposes related to healthcare services.
What information must be reported on Highmark ENR-163?
The form requires reporting information such as patient details, treatment information, billing codes, and any other required data pertinent to the services provided.
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