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Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.Paper Claim Submission Standards and Specifications Paper Claim StandardsCMS1500 Box/Field

How to fill out kaiser permanente paper claim

How to fill out kaiser permanente paper claim

1. Obtain the Kaiser Permanente paper claim form from their website or your local office.
2. Fill in your personal information including your name, address, and member ID number.
3. Provide information about the service you are claiming, including the date of service, provider's name, and provider's tax ID or National Provider Identifier (NPI).
4. Include a description of the services rendered and any relevant diagnosis codes.
5. Attach any supporting documents such as receipts or bills from the provider.
6. Review all information for accuracy before signing and dating the form.
7. Mail the completed claim form and documents to the address specified on the form.

Who needs kaiser permanente paper claim?

1. Members of Kaiser Permanente who have received healthcare services and wish to request reimbursement for out-of-pocket expenses.
2. People who have services rendered by non-Kaiser providers that are eligible for reimbursement under their Kaiser Permanente plan.
3. Patients who prefer to submit a paper claim rather than filing online or via the mobile app.

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What is kaiser permanente paper claim?

Kaiser Permanente paper claim is a method used by patients to request reimbursement for medical expenses incurred when using out-of-network providers, by submitting a written claim to Kaiser Permanente.

Who is required to file kaiser permanente paper claim?

Patients who receive care from non-Kaiser Permanente providers and wish to be reimbursed for those services are required to file a Kaiser Permanente paper claim.

How to fill out kaiser permanente paper claim?

To fill out a Kaiser Permanente paper claim, you must complete the claim form, provide details of the services received, attach relevant receipts or itemized bills, and sign the form before submitting it to the appropriate address.

What is the purpose of kaiser permanente paper claim?

The purpose of a Kaiser Permanente paper claim is to allow members to seek reimbursement for covered medical expenses incurred while receiving care from non-Kaiser Permanente providers.

What information must be reported on kaiser permanente paper claim?

The information that must be reported on a Kaiser Permanente paper claim includes the patient's identification details, provider information, dates of service, type of service provided, amount billed, and any applicable insurance policy numbers.