CA Blue Shield ICF-01 2018 free printable template
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Blue Shield of California. O. Box 2080, Oakland, California 946049716Individual Practitioner Information Change Form (ICF01)Dear Health Care Provider,
This form is used by Blue Shield of California
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How to fill out CA Blue Shield ICF-01
How to fill out CA Blue Shield ICF-01
01
Start by gathering the necessary personal information, such as your full name, address, and date of birth.
02
Provide your member identification number, which can be found on your CA Blue Shield card.
03
Fill out the section regarding your medical history, including any current medications and pre-existing conditions.
04
Complete the sections regarding your healthcare providers and their contact information.
05
Carefully read and understand the terms and conditions before signing the form.
06
Double-check all entries for accuracy before submitting the form.
Who needs CA Blue Shield ICF-01?
01
Individuals who are applying for coverage under CA Blue Shield.
02
Patients seeking benefits from their health insurance plan.
03
Those needing to provide detailed medical information for claim processing.
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People Also Ask about
How do I submit reimbursement to Blue Shield of California?
Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.
What is the fax number for prior authorization for Blue Shield of California?
Providers also have the option to complete and fax the California standard Prescription Drug Prior Authorization Request Form to (888) 697-8122.
Is Blue Shield of California the same as Blue Cross Blue Shield?
Blue Shield of California is a Registered® mark of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. Blue Shield of California and Mylifepath are service marks of Blue Shield of California.
What is the phone number for the Blue Shield of California Federal Employee Program provider?
(800) 824-8839 Go to our Virtual Events Dashboard to learn about the events we offer: Pre-retirement Seminars. New Employee Orientations.
How long do I have to file a claim Blue Shield of California?
Initial disputes must be submitted within 365 days, or the time specified in the provider's contract, whichever is greater, of Blue Shield's date of contest, denial, notice, or payment.
How do I submit a mental health claim to Blue Shield of California?
Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.
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What is CA Blue Shield ICF-01?
CA Blue Shield ICF-01 is a specific form issued by Blue Shield of California that is used for reporting certain health care information, particularly related to claims and insurance coverage.
Who is required to file CA Blue Shield ICF-01?
Entities such as health care providers, facilities, or organizations that engage in billing or submitting claims to Blue Shield of California are required to file CA Blue Shield ICF-01.
How to fill out CA Blue Shield ICF-01?
To fill out CA Blue Shield ICF-01, individuals or organizations must provide accurate details regarding patient information, services rendered, diagnosis codes, and any other required data as specified in the form's instructions.
What is the purpose of CA Blue Shield ICF-01?
The purpose of CA Blue Shield ICF-01 is to ensure accurate and efficient processing of health care claims and to provide necessary information to Blue Shield for reimbursement and record-keeping.
What information must be reported on CA Blue Shield ICF-01?
CA Blue Shield ICF-01 requires reporting of information such as patient demographics, detailed service information, diagnosis codes, billing codes, and provider identifiers.
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