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BARNWELL TECHNOLOGIES Louisiana Medicaid 835 Health Care Claim/Payment Advice Companion Debased on ASC X12N Version 005010×221A1CORE v5010 Master Companion Guide TemplateRevised January 2022Revision

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To fill out the www.bluecrossnc.com/document/835-health-care/835 healthcare claim payment advice, follow these steps:

02

Start by providing your personal information such as your name, address, and contact information.

03

Next, enter the patient's details, including their name, date of birth, and insurance information.

04

Specify the healthcare services for which you are seeking payment by providing the date of service and a detailed description of the procedures or treatments.

05

Include any supporting documentation such as receipts, medical reports, or pre-authorization forms.

06

Provide the total charges for the healthcare services and the amount already paid by the patient or their insurance company.

07

Indicate the preferred method of payment, whether it is a direct deposit, check, or electronic funds transfer.

08

Review the completed form for accuracy and make any necessary adjustments.

09

Sign and date the form to indicate your agreement with the provided information.

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Submit the filled-out form to the appropriate healthcare claim payment department or address as instructed.

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Anyone who has received healthcare services and is seeking payment from Blue Cross NC may need to fill out the www.bluecrossnc.com/document/835-health-care/835 healthcare claim payment advice. This includes healthcare providers, clinics, hospitals, and individual patients who want to get reimbursed for the covered services they received. It is an essential form for ensuring proper documentation and payment of healthcare claims.

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The wwwbluecrossnccomdocument835-health-care835 healthcare claim paymentadvice is a document that provides details of the payment made by Blue Cross NC for healthcare claims.

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Healthcare providers and facilities are required to file the wwwbluecrossnccomdocument835-health-care835 healthcare claim paymentadvice.

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To fill out the wwwbluecrossnccomdocument835-health-care835 healthcare claim paymentadvice, healthcare providers need to input the necessary claim and payment information in the designated fields.

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The purpose of the wwwbluecrossnccomdocument835-health-care835 healthcare claim paymentadvice is to provide transparency and accountability in the payment process for healthcare claims.

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The wwwbluecrossnccomdocument835-health-care835 healthcare claim paymentadvice must report details such as claim amount, payment amount, and payment method.

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