Highmark ENR-164 2013 free printable template
Show details
For Changes: High mark Health Insurance Company P.O. Box 890172 Camp Hill, PA 170890172MEMBER CHANGE FORM COMPLETE THIS APPLICATION IN ITS ENTIRETY IN BLUE OR BLACK INK. DO NOT USE PENCIL OR HIGHLIGHTER.APPLICANT
pdfFiller is not affiliated with any government organization
Get, Create, Make and Sign Highmark ENR-164
Edit your Highmark ENR-164 form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your Highmark ENR-164 form via URL. You can also download, print, or export forms to your preferred cloud storage service.
How to edit Highmark ENR-164 online
To use the professional PDF editor, follow these steps below:
1
Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit Highmark ENR-164. Replace text, adding objects, rearranging pages, and more. Then select the Documents tab to combine, divide, lock or unlock the file.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
With pdfFiller, it's always easy to deal with documents.
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
Highmark ENR-164 Form Versions
Version
Form Popularity
Fillable & printabley
How to fill out Highmark ENR-164
How to fill out Highmark ENR-164
01
Obtain a copy of the Highmark ENR-164 form.
02
Fill in the patient information section, including name, date of birth, and address.
03
Provide the insurance information, including the policy number and group number.
04
Complete the section detailing the physician or provider's information.
05
Specify the services or treatments being requested for coverage.
06
Sign and date the form where indicated.
07
Submit the form to Highmark via the appropriate method (mail, fax, or electronic submission).
Who needs Highmark ENR-164?
01
Individuals seeking insurance coverage for medical services.
02
Healthcare providers submitting claims for reimbursement from Highmark.
03
Patients who are enrolled in Highmark's insurance plans.
Fill
form
: Try Risk Free
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
Can I create an electronic signature for the Highmark ENR-164 in Chrome?
Yes. You can use pdfFiller to sign documents and use all of the features of the PDF editor in one place if you add this solution to Chrome. In order to use the extension, you can draw or write an electronic signature. You can also upload a picture of your handwritten signature. There is no need to worry about how long it takes to sign your Highmark ENR-164.
How do I edit Highmark ENR-164 straight from my smartphone?
You may do so effortlessly with pdfFiller's iOS and Android apps, which are available in the Apple Store and Google Play Store, respectively. You may also obtain the program from our website: https://edit-pdf-ios-android.pdffiller.com/. Open the application, sign in, and begin editing Highmark ENR-164 right away.
Can I edit Highmark ENR-164 on an iOS device?
You can. Using the pdfFiller iOS app, you can edit, distribute, and sign Highmark ENR-164. Install it in seconds at the Apple Store. The app is free, but you must register to buy a subscription or start a free trial.
What is Highmark ENR-164?
Highmark ENR-164 is a form used by healthcare providers and organizations to report essential information related to enrollment and eligibility for their health plans.
Who is required to file Highmark ENR-164?
Healthcare providers, facilities, and organizations that are submitting claims or seeking reimbursement from Highmark for their services are required to file Highmark ENR-164.
How to fill out Highmark ENR-164?
To fill out Highmark ENR-164, you need to provide accurate and complete information in all required fields, including patient details, provider information, and service codes, following the guidelines provided by Highmark.
What is the purpose of Highmark ENR-164?
The purpose of Highmark ENR-164 is to facilitate the efficient processing of enrollment and eligibility information to ensure that claims are handled accurately and promptly.
What information must be reported on Highmark ENR-164?
Information that must be reported on Highmark ENR-164 includes the patient's identifying information, insurance policy numbers, service dates, provider details, and any other relevant data that supports the enrollment process.
Fill out your Highmark ENR-164 online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Highmark ENR-164 is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
