Web• Mail this form and your original documents to the following address: Blue Cross and Blue Shield of Nebraska P.O. Box 261279 Plano, TX 75026 I certify the above information is true, the enclosed material is correct and unaltered, and the expenses were incurred by the enrollee listed above. False receipts or altering of this information will ... Web• Mail this form and your original documents to the following address: Blue Cross and Blue Shield of Nebraska. P.O. Box 261279. Plano, TX 75026 Member’s signature: Date: …
Medical Policy and Pre-certification/Pre-authorization Information …
WebSimply fill out the form or call 888-926-1203. First Name Last Name Email Address Phone Number Date of Birth Would you like to include your spouse? Number of Children (if applicable) I am under age 65 and a resident of Nebraska. By providing my phone number and email address. Web50-091 (08-17-21) Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association Electronic Funds Transfer Enrollment Request Name: Email: Phone Number: Office Address: Fax: Billing Address: Contact Name: City: City: State: State: ZIP: ZIP: Tax ID: NPI: Check if NPI Type II Printed name and role ... skin script raspberry cleanser
BCBSNE Medical Policy - NebraskaBlue
WebThe Member ID and group number can be found on your Blue Cross and Blue Shield of. Nebraska ID card ... This is a Dental Benefit that will be reimbursed to the . member. Please submit a separate form for each date of service. Dental Providers: If you are helping the member complete this . form, please send it to the Plano, TX processing center ... WebPlease include any written comments, office notes, operative reports, or other relevant information for Blue Cross and Blue Shield of Nebraska to consider during their review. A written request for an appeal can be faxed to 402-548-4684 or 888-492-4944; or it can be mailed to: Appeals Department, Blue Cross and Blue Shield of Nebraska, PO Box 3248, WebImportant Legal Information:: Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage, Highmark Benefits Group, Highmark Senior Health Company, First Priority Health and/or First Priority Life provide health benefits and/or health benefit administration in the 29 counties of ... swansea bournemouth