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AB CDE Regence BlueCross BlueShield of Oregon 100 SW Market Street Portland Oregon 97207-1271 Mail form to PO Box 1271 MS WW4-43C Portland OR 97207-9861 Fax to 1 888 661-2850 Today s Date Subscriber Name ID Number Group Number OTHER COVERAGE QUESTIONNAIRE Your Regence BlueCross BlueShield of Oregon Regence contract may contain a Coordination of Benefits COB provision. We depend upon your help in order for us to process your claims correctly and appreciate your prompt and accurate reply. If...
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