CareFirst BCBS CUT0166-1S 2014 free printable template

Vision/Eye Care Claim Form PATIENT AND SUBSCRIBER INFORMATION 1. PATIENT S NAME (First, Middle Initial, Last Name) 2. PATIENT S DATE OF BIRTH 3. SUBSCRIBER S NAME (First, Middle Initial, Last Name)

How to fill out CareFirst BCBS CUT0166-1S

How to fill out CareFirst BCBS CUT0166-1S

1. Obtain the CareFirst BCBS CUT0166-1S form from the official website or your insurance provider.
2. Carefully read the instructions provided on the form before starting.
3. Fill in your personal information in the designated fields, including your name, address, and contact information.
4. Provide your policy number and date of birth as requested on the form.
5. Indicate the services or claims you are submitting for reimbursement or review.
6. Attach any necessary documentation, such as bills or treatment summaries, that support your claim.
7. Review all the entered information for accuracy and completeness.
8. Sign and date the form at the bottom as required.
9. Submit the completed form by mail, fax, or electronically, as specified in the instructions.

Who needs CareFirst BCBS CUT0166-1S?

1. Individuals covered under a CareFirst BCBS insurance plan who need to submit a claim for reimbursement.
2. Healthcare providers seeking to bill CareFirst BCBS for services rendered to their patients.
3. Patients who have received services and need to provide proof of services for reimbursement from their insurance.

People Also Ask about

How do I submit a claim to Metlife vision?

The IVR function is available at 1-800-880-1800. Need to Submit an E-claim? Send your vision care claims electronically to InMediata (formerly ANS) and they will forward them to our claims processing center.

How do I contact BCBS Texas?

Call us at 1-866-292-6745 (TTY 711). We're open between 8 a.m. – 8 p.m., local time, 7 days a week.

How do I submit a claim to BCBS Texas?

If you have any questions about the submission process or about your claim, you can call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039 (TTY:711), Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT.

What is the payer ID for BCBS of Texas claims?

All claims should be submitted electronically. The Electronic Payor ID for BCBSTX is 84980.

How long do you have to file claims with BCBSTX?

Participating physicians, professional providers, ancillary and facility providers are requested to submit claims electronically to Blue Cross and Blue Shield of Texas (BCBSTX) within 95 days of the date of service, or by using the standard CMS-1500 or UB04 claim form.

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What is CareFirst BCBS CUT0166-1S?

CareFirst BCBS CUT0166-1S is a specific form used by CareFirst BlueCross BlueShield for reporting certain healthcare data and claims.

Who is required to file CareFirst BCBS CUT0166-1S?

Healthcare providers, including doctors, hospitals, and other facilities that provide services billed to CareFirst, are typically required to file CareFirst BCBS CUT0166-1S.

How to fill out CareFirst BCBS CUT0166-1S?

To fill out CareFirst BCBS CUT0166-1S, you need to provide patient information, service details, billing codes, and any other required documentation as specified by the form instructions.

What is the purpose of CareFirst BCBS CUT0166-1S?

The purpose of CareFirst BCBS CUT0166-1S is to ensure accurate reporting and processing of healthcare claims and to facilitate proper reimbursement from CareFirst.

What information must be reported on CareFirst BCBS CUT0166-1S?

The information that must be reported on CareFirst BCBS CUT0166-1S includes patient demographics, provider information, service dates, diagnosis codes, procedure codes, and billing amounts.