Sanford Health Plan HP-1395 2018-2025 free printable template
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Coordination of Benefits
1749 38th Street S.
Fargo ND 58103Coordination of Benefits
Customer Service: (800) 7525863
PAPERS Customer Service: (800) 4993416
Questionnaire
ND Medicaid Expansion Customer
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How to fill out Sanford Health Plan HP-1395
How to fill out Sanford Health Plan HP-1395
01
Gather all necessary personal information, including your name, address, and contact details.
02
Obtain the required information about your insurance coverage and policy number.
03
Fill out the sections related to your health history and current medical conditions.
04
Provide details about any medications you are currently taking.
05
Review the form for accuracy and completeness before submission.
06
Submit the completed form to the appropriate department or as instructed.
Who needs Sanford Health Plan HP-1395?
01
Individuals seeking health insurance coverage through Sanford Health.
02
People who are applying for new health plans or renewing existing coverage.
03
Families looking to enroll their dependents in a health insurance plan.
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What is Sanford Health Plan HP-1395?
Sanford Health Plan HP-1395 is a specific health plan offered by Sanford Health that provides health insurance coverage to eligible members.
Who is required to file Sanford Health Plan HP-1395?
Individuals who are enrolled in the Sanford Health Plan and seeking coverage for specific health services are required to file Sanford Health Plan HP-1395.
How to fill out Sanford Health Plan HP-1395?
To fill out Sanford Health Plan HP-1395, members need to provide their personal information, a description of services sought, and any necessary medical documentation.
What is the purpose of Sanford Health Plan HP-1395?
The purpose of Sanford Health Plan HP-1395 is to facilitate the submission of claims and requests for reimbursement for covered health services under the plan.
What information must be reported on Sanford Health Plan HP-1395?
Required information on Sanford Health Plan HP-1395 includes member identification details, provider information, service dates, and the nature of the health services provided.
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