Regence 5275WA 2017-2025 free printable template
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Fax to: 1-866-303-5117. Washington Application For Enrollment/Change (for groups 1-50). Please print in black ink. Incomplete and/or illegible information may ...
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How to fill out regence application form
How to fill out Regence 5275WA
01
Obtain the Regence 5275WA form from the Regence website or your healthcare provider.
02
Carefully read the instructions provided on the form.
03
Fill in your personal information, including your name, address, and contact details.
04
Indicate your insurance policy number and any other relevant identification numbers.
05
Provide details about the medical services or claims you are submitting.
06
Include dates of service and itemize any charges if applicable.
07
Sign and date the form where indicated.
08
Review the completed form for accuracy before submission.
09
Submit the form to the address specified in the instructions, either by mail or electronically.
Who needs Regence 5275WA?
01
Individuals who have received medical services covered by Regence Health Insurance.
02
Patients seeking reimbursement for out-of-pocket medical expenses.
03
Members who need to report a claim for healthcare services received.
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What is Regence 5275WA?
Regence 5275WA is a specific form used for reporting health insurance claims and related information in the state of Washington.
Who is required to file Regence 5275WA?
Health care providers and insurers who provide medical services and submit claims in Washington state are required to file Regence 5275WA.
How to fill out Regence 5275WA?
To fill out Regence 5275WA, gather all necessary patient and claim information, complete the required fields including patient demographics, service codes, and billing details, then submit the form as per the guidelines provided by Regence.
What is the purpose of Regence 5275WA?
The purpose of Regence 5275WA is to facilitate the accurate reporting and processing of health insurance claims to ensure proper reimbursement and compliance with state regulations.
What information must be reported on Regence 5275WA?
Information required on Regence 5275WA includes patient identification details, service dates, procedure codes, and billing codes, as well as any other relevant clinical information as specified by Regence.
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