CA Blue Shield CLM14850 2024-2025 free printable template

Subscriber’s statement of claim Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540. Please note that this form is to be used only when the provider of service

How to fill out

How to fill out CA Blue Shield CLM14850

1. Gather necessary patient information, including name, address, and policy number.
2. Fill out the claim form header with the provider's details, including name and NPI number.
3. Provide the patient’s treatment date(s) in the appropriate section.
4. List all services rendered, including the corresponding procedure codes and diagnosis codes.
5. Indicate the total charges for each service in the total charge section.
6. Complete the payment section, noting any prior payments made by the patient or insurance.
7. Include all supporting documentation, such as itemized bills or medical records, if required.
8. Review the entire claim form thoroughly for accuracy before submission.
9. Submit the completed form via the method specified by CA Blue Shield, whether electronically or by mail.
10. Keep a copy of the submitted claim for your records.

Who needs CA Blue Shield CLM14850?

1. Healthcare providers submitting claims for services rendered to patients covered by CA Blue Shield.
2. Patients who need to claim reimbursement for out-of-pocket medical expenses.
3. Medical facilities that require reimbursement from CA Blue Shield for treatment provided.

People Also Ask about

How do I submit reimbursement to Blue Shield of California?

Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

How long does it take for Blue Shield of California to process claims?

To start the exception request process, call the Shield Concierge (HMO) or Customer Service (PPO) phone number on the back of your ID card. Blue Shield or the Benefit Administrator will process your claim within 30 business days of receipt if it is not missing any required information.

What is included in a claim form?

The claim form must contain 'a concise statement of the nature of the claim' (CPR 16.2(1)(a)). The claimant needs to identify in outline the cause, or causes, of action that are being pursued.

How to fill claim form part A?

You can proceed to fill out part A of the form by entering a few primary details of yours, including your full name, policy number, residential address, phone number, and e-mail id. Then, you may need to provide the details of your medical history and hospitalisation.

What is a claim form for insurance?

noun. (Insurance: Claims) A claim form is a standard printed document used for submitting a claim. Under normal circumstances, reimbursement will take place within ten days of receipt and approval of claim form and all required documents.

How do I submit a mental health claim to Blue Shield of California?

Provider Customer Service Department. Phone:(800) 541-6652. Blue Shield mental health service administrator for HMO and PPO commercial plan members. Phone:(877) 263-9952.

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What is CA Blue Shield CLM14850?

CA Blue Shield CLM14850 is a specific claim form used by Blue Shield of California for the processing of certain health care claims.

Who is required to file CA Blue Shield CLM14850?

Providers and healthcare professionals who wish to claim reimbursement for services provided to patients enrolled in Blue Shield of California are typically required to file CA Blue Shield CLM14850.

How to fill out CA Blue Shield CLM14850?

To fill out CA Blue Shield CLM14850, providers should enter patient information, service codes, dates of service, provider details, and any relevant billing information clearly and accurately as per the instructions accompanying the form.

What is the purpose of CA Blue Shield CLM14850?

The purpose of CA Blue Shield CLM14850 is to facilitate the processing and reimbursement of health care claims for services rendered to patients by Blue Shield providers.

What information must be reported on CA Blue Shield CLM14850?

The information that must be reported on CA Blue Shield CLM14850 includes patient details, service dates, procedure codes, diagnosis codes, billing amounts, provider information, and any other relevant documentation as required by Blue Shield.