Get the free 20151117 BCBST Physician Form (20267 - Activated, Traditional)

PRIMARY CARE PHYSICIAN. BIOMETRIC SCREENING FORM. MAN. . Filename. Last Name ... BCPST Subscriber Number. Hours. Fasted ... Yes. No. I am taking medication for: N/A. Blood Pressure. Cholesterol. Diabetes.

How to fill out 20151117 bcbst physician form

Who needs the 20151117 bcbst physician form?

1. Healthcare providers who are contracted with BlueCross BlueShield of Tennessee (BCBST) and need to submit claims for reimbursement.
2. Physicians, specialists, and other healthcare professionals who provide services to BCBST members.
3. Anyone who wants to ensure timely and accurate reimbursement for the medical services they have provided.

How to fill out the 20151117 bcbst physician form:

1. Begin by entering the date of service in the designated field on the form.
2. Provide the patient's personal information, including their name, date of birth, and BCBST member ID number.
3. Specify the patient's insurance plan details, such as the group or individual plan name and number.
4. Indicate the patient's diagnosis and the corresponding International Classification of Diseases (ICD) code in the appropriate section.
5. Detail the services provided by selecting the appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code for each service rendered.
6. Include any relevant modifiers if necessary, such as indicating multiple procedures or services performed during the same visit.
7. Calculate and enter the charges for each service and any applicable discounts or adjustments.
8. If the patient has other insurance coverage, provide details about the secondary insurance company in the designated section.
9. Sign and date the form to certify the accuracy of the information provided.
10. Keep a copy of the completed form for your records and submit it according to the BCBST guidelines for claims submission.

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