CIGNA LMS-613500 2006-2025 free printable template
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Pittsburgh Claim Service Center P. O. Box 22328 Pittsburgh PA 15222-0328 1-800-238-2125 Toll Free Group/Association - Proof of Loss Life Insurance Accidental Death Insurance Connecticut General Life Insurance Company CIGNA Life Insurance Company of New York LMS-613500 Rev. 09/2006 Clear Fields FRAUD WARNING Any person who knowingly and with intent to defraud any insurance company or other person 1 files an application for insurance or statement of claim containing any materially false...
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How to fill out 2006 lms613500 get form
How to fill out CIGNA LMS-613500
01
Obtain the CIGNA LMS-613500 form from the CIGNA website or your employer's HR department.
02
Review the form instructions carefully before starting.
03
Fill out your personal information at the top of the form, including your name, address, and contact details.
04
Provide policy or account numbers as requested in the appropriate sections.
05
Complete all required fields, including any relevant health history or claims information.
06
Attach any necessary supporting documentation, such as receipts or medical records.
07
Review your completed form for accuracy and completeness.
08
Sign and date the form where indicated.
09
Submit the form either online, by mail, or as directed by CIGNA.
Who needs CIGNA LMS-613500?
01
Individuals enrolled in CIGNA health insurance plans.
02
Employees seeking to file claims for healthcare services.
03
Dependents or beneficiaries needing to submit documentation for benefits.
04
Anyone who has received medical treatment and requires reimbursement from CIGNA.
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What is CIGNA LMS-613500?
CIGNA LMS-613500 is a specific form used for reporting certain health insurance claims and data to CIGNA, typically related to medical and healthcare services.
Who is required to file CIGNA LMS-613500?
Providers that render services covered by CIGNA, as well as those involved in claims processing and healthcare reporting, are generally required to file CIGNA LMS-613500.
How to fill out CIGNA LMS-613500?
To fill out CIGNA LMS-613500, providers must provide accurate patient information, details of the healthcare services rendered, billing codes, and any other required documentation as specified in the instructions accompanying the form.
What is the purpose of CIGNA LMS-613500?
The purpose of CIGNA LMS-613500 is to facilitate accurate and efficient processing of health insurance claims to ensure proper reimbursement for services provided and to maintain compliance with healthcare regulations.
What information must be reported on CIGNA LMS-613500?
Required information on CIGNA LMS-613500 includes patient demographic data, service dates, diagnostic and procedure codes, provider details, and any necessary attachments or supporting documentation.
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