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Regency Bluesier of Washington Mail form to: PO Box 1271 Portland, OR 972071271 Fax to: 18663035117Application For Enrollment/Change (101+) Please print in black ink. Incomplete and/or illegible information
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Step 1: Obtain the application form from Regence Blueshield of Washington or download it from their official website.
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Step 2: Read the instructions carefully to understand the information required for each section.
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Step 3: Provide your personal details in the designated fields, including your full name, date of birth, address, and contact information.
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Step 4: Fill in the necessary information regarding your current health insurance coverage, if applicable.
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Step 5: Specify the type of plan you are applying for, such as individual, family, or group coverage.
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Step 6: Provide information about your dependents, if any, including their names and relationship to you.
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Step 7: Fill out the section related to your employment information, including your employer's name and address.
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Step 8: Answer the health-related questions accurately, as it may impact your eligibility for coverage.
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Step 9: Review the completed form to ensure all the information provided is accurate and up-to-date.
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Step 10: Sign and date the form, and attach any required supporting documents.
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Step 11: Submit the filled-out form to Regence Blueshield of Washington through mail, fax, or online submission, as specified in the instructions.
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Step 12: Wait for a response from Regence Blueshield of Washington regarding your application.
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Step 13: Once approved, you will receive your Regence Blueshield of Washington coverage details and membership card.

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Regence BlueShield of Washington is a health insurance provider in the state of Washington.
Healthcare providers, hospitals, and other healthcare entities are required to file Regence BlueShield of Washington.
Regence BlueShield of Washington can be filled out online through their website or by submitting paper forms through mail.
The purpose of Regence BlueShield of Washington is to report healthcare services provided to members of the insurance plan.
Information such as patient demographics, diagnosis codes, procedure codes, and billing amounts must be reported on Regence BlueShield of Washington.
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