Bcbsnc Prescription Claim Form - Page 2

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What is bcbsnc prescription claim form?

The bcbsnc prescription claim form is a document used by Blue Cross Blue Shield of North Carolina (BCBSNC) members to request reimbursement for prescription medications. This form allows members to provide the necessary information for BCBSNC to process their claim and issue reimbursement.

What are the types of bcbsnc prescription claim form?

There are different types of bcbsnc prescription claim forms available based on the specific needs of the member. The most commonly used types include: 1. Standard Prescription Claim Form: This form is used for general reimbursement requests. 2. Specialty Medication Claim Form: This form is used for specialty medications that require additional information. 3. Mail Order Pharmacy Claim Form: This form is used for reimbursement requests related to mail-order pharmacy services. 4. Prior Authorization Exception Request Form: This form is used to request authorization for medications that require prior approval. 5. Coordination of Benefits (COB) Prescription Claim Form: This form is used when a member has primary coverage with another insurance provider.

Standard Prescription Claim Form

Specialty Medication Claim Form

Mail Order Pharmacy Claim Form

Prior Authorization Exception Request Form

Coordination of Benefits (COB) Prescription Claim Form

How to complete bcbsnc prescription claim form

Completing the bcbsnc prescription claim form is a straightforward process. Here are the steps involved: 1. Download the appropriate claim form from the BCBSNC website or obtain a physical copy from your healthcare provider. 2. Fill in your personal information, including your name, address, and BCBSNC member ID. 3. Provide details about the prescription medication, including the name, dosage, and quantity. 4. Attach the original pharmacy receipt and a copy of the prescription. 5. Sign and date the form. 6. Submit the completed form along with supporting documents to BCBSNC for review and processing.

01

Download the appropriate claim form

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Fill in your personal information

03

Provide details about the prescription medication

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Attach the original pharmacy receipt and a copy of the prescription

05

Sign and date the form

06

Submit the completed form along with supporting documents

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Questions & answers

How do I get reimbursed for Covid test in BCBS NC?

Most Blue Cross NC members should not need reimbursement for their OTC COVID-19 tests.When submitting a claim to be reimbursed, members must mail a: Completed OTC COVID-19 test claim form* Purchase receipt documenting the date of purchase and the price of the test. The test's UPC code.

How do I file a claim with BCBS of Florida?

How do I submit a claim? If your provider or pharmacy is in your plan's network, they'll submit the claim for you. If you saw an out-of-network provider, you'll need to submit a medical claim form. If this was for emergency care, call us first at 800-352-2583 to see if a claim was filed.

What is the payer ID for BCBS NC?

The Healthy Blue + Medicare Payer ID is North Carolina - 00602.

How do I submit a claim to Bcbsnc?

Visit BlueCrossNC.com/Claims for prescription drug, dental and international claim forms, or call the toll-free number on your ID card. Important Notes When Completing the Claim Form: Type or use blue or black ink to complete. Complete a separate claim form for each covered family member.

Is OptumRx part of UnitedHealthcare?

OptumRx and BriovaRx are subsidiaries of UnitedHealth Group. UnitedHealthcare and the dimensional U logo are trademarks of UnitedHealth Group Incorporated. All other trademarks are the property of their respective owners.

How do I submit a prescription to OptumRx?

(OptumRx Mail Service) 6800 W 115th St, Suite 600 Overland Park, KS 66211-9838 NCPDP: 17188634 Call 1-800-791-7658 – Provide a verbal prescription directly to an Optum Rx provider dedicated pharmacist. Fax 1-800-491-7997 – Send a complete prescription using the Physician Fax Form.

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