PA Independence Blue Cross Form 18825 2020-2025 free printable template

Independence Blue Cross 1901 Market Street, Philadelphia, PA 19103 Application for New Employer Health Benefits 51+This form and plan designs can only be used when a group has 51+ total employees.

How to fill out PA Independence Blue Cross Form 18825

How to fill out PA Independence Blue Cross Form 18825

1. Obtain the PA Independence Blue Cross Form 18825 from the official website or your local office.
2. Carefully read the instructions provided on the form.
3. Fill out your personal information at the top, including your name, address, date of birth, and member ID number.
4. Indicate the type of coverage you are applying for by checking the appropriate boxes.
5. Provide information about any dependents you wish to include in the plan.
6. Complete any required health history questions accurately.
7. Sign and date the form where indicated.
8. Review your form for any errors or missing information.
9. Submit the completed form via the instructed method (mail, fax, or online submission).

Who needs PA Independence Blue Cross Form 18825?

1. Individuals seeking health insurance coverage in Pennsylvania through Independence Blue Cross.
2. People looking to enroll for the first time or change their current health insurance plan.
3. Persons who qualify for assistance programs related to health insurance.

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What is PA Independence Blue Cross Form 18825?

PA Independence Blue Cross Form 18825 is a medical claims form used to report and process healthcare services provided to patients under the Independence Blue Cross insurance plan in Pennsylvania.

Who is required to file PA Independence Blue Cross Form 18825?

Healthcare providers and facilities that render services to patients insured by Independence Blue Cross are required to file PA Independence Blue Cross Form 18825 in order to claim payment for those services.

How to fill out PA Independence Blue Cross Form 18825?

To fill out PA Independence Blue Cross Form 18825, providers must enter patient details, service rendered, diagnosis codes, procedure codes, and any relevant billing information as instructed on the form. It's essential to ensure accuracy to avoid claim denials.

What is the purpose of PA Independence Blue Cross Form 18825?

The purpose of PA Independence Blue Cross Form 18825 is to facilitate the reimbursement process for medical services provided to members of the Independence Blue Cross plan by documenting necessary information for claims processing.

What information must be reported on PA Independence Blue Cross Form 18825?

The information that must be reported on PA Independence Blue Cross Form 18825 includes the patient's personal and insurance details, the provider's information, details of the services rendered, corresponding diagnosis codes, procedure codes, dates of service, and itemized billing amounts.