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EXTENDED HEALTH CARE and VISION CARE CLAIM Claims that are faxed, emailed, unsigned or do not have original receipts attached will be returned COVERED MEMBER INFORMATION* (Please print) Covered members

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How to fill out claims that are faxed

01

Step 1: Gather all the necessary documents and information that are needed to file the claim, such as medical records, receipts, and proof of payment.

02

Step 2: Ensure that you have the correct claim form from the insurance company. This form can usually be obtained from their website or by contacting their customer service.

03

Step 3: Fill out the claim form accurately and completely. Make sure to provide all the necessary details such as patient information, policy number, date of service, and description of the claim.

04

Step 4: Double-check the filled-out form for any errors or missing information. Providing incomplete or incorrect information may result in delays or denial of the claim.

05

Step 5: Prepare the supporting documents, such as medical records and receipts, to be faxed along with the claim form.

06

Step 6: Ensure that the fax machine is in good working condition and has enough paper and ink.

07

Step 7: Dial the fax number provided by the insurance company and send the fax with the completed claim form and supporting documents.

08

Step 8: Keep a copy of the transmitted fax confirmation as proof of submission.

09

Step 9: Follow up with the insurance company to ensure that they have received the faxed claim and all required documents.

10

Step 10: Monitor the progress of the claim and be prepared to provide any additional documentation or information if requested by the insurance company.

Who needs claims that are faxed?

01

Individuals and businesses who have incurred eligible expenses and are seeking reimbursement from their insurance company.

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What is claims that are faxed?

Claims that are faxed refer to insurance claims that are submitted via fax machine.

Who is required to file claims that are faxed?

Healthcare providers and facilities are required to file claims that are faxed to insurance companies or third-party payers.

How to fill out claims that are faxed?

Claims that are faxed must be filled out completely and accurately, including patient information, diagnosis codes, procedure codes, and provider information.

What is the purpose of claims that are faxed?

The purpose of claims that are faxed is to request reimbursement from insurance companies or third-party payers for healthcare services provided to patients.

What information must be reported on claims that are faxed?

Claims that are faxed must include patient demographics, provider information, diagnosis codes, procedure codes, dates of service, and any other required documentation.

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