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For service received outside the carefirst bluecross blueshield service area maryland washington dc and northern virginia the claim form and all related materials should be submitted to your local blue cross and blue shield plan.

Carefirst health benefits claim form. For service received outside the carefirst bluecross blueshield service area maryland washington dc and northern virginia the claim form and all related materials should be submitted to your local blue cross and blue shield plan. And northern virginia providing flexibility and superior service through the most trusted name in health carelocally through carefirst bluecross blueshield and nationally through the blue cross blue shield association. Health benefits claim form. This applies to the following types of claims.

Carefirst bluecross blueshield reserves the right to make payment directly to the subscriber and to refuse to honor the assignment of any claim to any person or party. Start a free trial now to save yourself time and money. See reverse side for filing information please complete each numbered itemfailure to do so may result in delays in processing your claim. Please complete a separate claim form for each provider.

Billing dme on a cms 1500 claim form. Medicare crossover claims submission. If you have. Carefirst administrators cfa is the only third party administrator in maryland dc.

Certain claims require additional documentation and cannot be submitted electronically. Specifc requirements of a members health benefts vary and may differ from the general procedures outlined in this manual. Please type or print. Professional provider manual carefirst.

Clear photocopy of the other carriers explanation of benefits form is acceptable in place of the original document. To support our paperless initiative and improve your claims processing experience carefirst strongly encourages participating and non participating providers to submit all claims electronically. Clear photocopy of the other carriers explanation of benefits form is acceptable in place of the original document. For service received outside the carefirst bluecross blueshield service area maryland washington dc and northern virginia the claim form and all related materials should be submitted to your local blue cross and blue shield plan.

This form is to be used only by members of the state employees health plan to file ppo pos and epo claims. While participating providers will bill while participating providers will bill carefirst bluecross blueshield for services rendered you may have claims to file yourself if you see non participating providers. The most secure digital platform to get legally binding electronically signed documents in just a few seconds. Clear photocopy of the other carriers explanation of benefits form is acceptable in place of the original document.

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