CA Blue Shield CLM14850 2010 free printable template

Subscriber s Statement of Claim Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540. This form is to be used only when the provider of service does not submit your

How to fill out CA Blue Shield CLM14850

How to fill out CA Blue Shield CLM14850

1. Begin with the patient’s personal information, including name, date of birth, and address.
2. Fill in the insurance policy number and the group number if applicable.
3. Indicate the type of claim being submitted (e.g., medical, dental).
4. Provide details of the services rendered, including dates of service and descriptions.
5. Include the provider’s information, such as name, address, and National Provider Identifier (NPI) number.
6. Attach any necessary supporting documents, such as receipts or additional medical records.
7. Review the completed form for accuracy before submitting.
8. Send the form to the appropriate claim processing address provided by CA Blue Shield.

Who needs CA Blue Shield CLM14850?

1. Individuals who have received medical or dental services covered under CA Blue Shield.
2. Providers needing to submit claims for reimbursement on behalf of their patients.
3. Patients seeking to request reimbursement for out-of-pocket expenses.

People Also Ask about

How do I submit reimbursement to Blue Shield of California?

Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

How long does it take for Blue Shield of California to process claims?

To start the exception request process, call the Shield Concierge (HMO) or Customer Service (PPO) phone number on the back of your ID card. Blue Shield or the Benefit Administrator will process your claim within 30 business days of receipt if it is not missing any required information.

What is included in a claim form?

The claim form must contain 'a concise statement of the nature of the claim' (CPR 16.2(1)(a)). The claimant needs to identify in outline the cause, or causes, of action that are being pursued.

How to fill claim form part A?

You can proceed to fill out part A of the form by entering a few primary details of yours, including your full name, policy number, residential address, phone number, and e-mail id. Then, you may need to provide the details of your medical history and hospitalisation.

What is a claim form for insurance?

noun. (Insurance: Claims) A claim form is a standard printed document used for submitting a claim. Under normal circumstances, reimbursement will take place within ten days of receipt and approval of claim form and all required documents.

How do I submit a mental health claim to Blue Shield of California?

Provider Customer Service Department. Phone:(800) 541-6652. Blue Shield mental health service administrator for HMO and PPO commercial plan members. Phone:(877) 263-9952.

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What is CA Blue Shield CLM14850?

CA Blue Shield CLM14850 is a specific form used in California for health insurance claims processing related to services provided under Blue Shield insurance plans.

Who is required to file CA Blue Shield CLM14850?

Providers and healthcare professionals who deliver services covered by Blue Shield of California are required to file the CA Blue Shield CLM14850 form to process claims for reimbursement.

How to fill out CA Blue Shield CLM14850?

To fill out CA Blue Shield CLM14850, enter the patient's information, insurance details, service dates, and itemized charge information as required, ensuring all mandatory fields are completed accurately.

What is the purpose of CA Blue Shield CLM14850?

The purpose of CA Blue Shield CLM14850 is to facilitate the submission of healthcare claims to Blue Shield of California for reimbursement for services rendered to insured individuals.

What information must be reported on CA Blue Shield CLM14850?

The information that must be reported on CA Blue Shield CLM14850 includes patient demographics, provider details, insurance policy number, service codes, dates of service, and requested reimbursement amounts.