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1267 Professional Parkway Gainesville, GA 30507NCPDP Version D.0 Commercial Payer Sheet Payer Name: Procure IBM Plan Name/Group Name: Procure IBM East (INSURED)GENERAL INFORMATION Date: 07/01/2020

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How to fill out bin-900020-msainsurcardprocarepayersheetd0upd03062020 2

01

Start by entering the date on the payer sheet in the designated field.

02

Next, fill out the patient information section including name, ID number, and date of birth.

03

Provide the insurance information including the BIN number (900020), group number, and member ID.

04

Complete the remaining fields including the provider information, treatment details, and any additional notes.

Who needs bin-900020-msainsurcardprocarepayersheetd0upd03062020 2?

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Healthcare providers who are submitting claims to MSainsurcard ProCare would need to fill out bin-900020-msainsurcardprocarepayersheetd0upd03062020.

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