Get Ca Blue Shield Clm14850 2002

An insurance claim form is an insurance document that is used by insurance holders to inform insurance companies about an accident or illness. With this form, insurance holders can submit relevant information such as their insurance plan, patient's name, nature of the injury or sickness, amount to be paid, and so on.

The subscriber is the person subscribing to or carrying the insurance plan for the patient case. How is the patient related to the subscriber? For example, if the subscriber is the mother of the patient, then the Patient Relationship to Subscriber is Child.

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.

The person who pays for health insurance premiums or whose employment is the basis for membership in the insurance plan. For example, if you have health insurance through your spouse's health insurance plan, he or she is the primary subscriber.

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 to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.