Submitting a Blue Cross Blue Shield Global Core Claim Sample Clauses

Submitting a Blue Cross Blue Shield Global Core Claim. When Enrolled Members pay for covered healthcare services outside the BlueCard service area, they must submit a claim to obtain reimbursement. For institutional and professional claims, Enrolled Members should complete a Blue Cross Blue Shield Global Core claim form and send the claim form with the provider’s itemized xxxx(s) to the service center address on the form to initiate claims processing. The claim form is available from BCBSRI, the service center, or online at xxx.xxxxxxxxxxxxxx.xxx. If Enrolled Members need assistance with their claim submissions, they should call the service center at 0.000.000.XXXX (2583) or call collect at 0.000.000.0000, 24 hours a day, seven days a week.
Sample 1Sample 2Sample 3See All (11)
AutoNDA by SimpleDocs
Submitting a Blue Cross Blue Shield Global Core Claim. When the Member pays for Covered Medical Services outside the BlueCard service area, the Member must submit a claim to obtain reimbursement. For institutional and professional claims, the Member should complete a Blue Cross Blue Shield Global Core International claim form and send the claim form with the provider’s itemized bill(s) to the service center (the address is on the form) to initiate claims processing. Following the instructions on the claim form will help ensure timely processing of the Member’s claim. The claim form is available from Blue Cross and Blue Shield of Montana, the service center or online at xxx.xxxxxxxxxxxxxx.xxx. If the Member needs assistance with the Member claim submission, the Member should call the service center at 0-000-000-XXXX (2583) or call collect at 0-000-000-0000, 24 hours a day, seven days a week. Complaints and Grievances‌ The Plan has established a Complaint and Grievance process. A complaint involves a communication from the Member expressing dissatisfaction about The Plan’s services or lack of action or disagreement with The Plan’s response. A grievance will typically involve a complaint about a provider or a provider’s office and may include complaints about a provider’s lack of availability or quality of care or services received from a provider’s staff. Most problems can be handled by calling Customer Service at the number appearing on the inside cover of this Contract. The Member may also file a written complaint or grievance with The Plan. The fax number, email address, and mailing address of The Plan appears on the inside cover of this Contract. Written complaints or grievances will be acknowledged within 3 days of receipt. The Member will be notified of The Plan’s response within 60 days from receipt of the Member’s written complaint or grievance.
Sample 1

Related to Submitting a Blue Cross Blue Shield Global Core Claim

  • CHILD AND DEPENDENT ADULT/ELDER ABUSE REPORTING CONTRACTOR shall establish a procedure acceptable to ADMINISTRATOR to ensure that all employees, agents, subcontractors, and all other individuals performing services under this Contract report child abuse or neglect to one of the agencies specified in Penal Code Section 11165.9 and dependent adult or elder abuse as defined in Section 15610.07 of the WIC to one of the agencies specified in WIC Section 15630. CONTRACTOR shall require such employees, agents, subcontractors, and all other individuals performing services under this Contract to sign a statement acknowledging the child abuse reporting requirements set forth in Sections 11166 and 11166.05 of the Penal Code and the dependent adult and elder abuse reporting requirements, as set forth in Section 15630 of the WIC, and shall comply with the provisions of these code sections, as they now exist or as they may hereafter be amended.

  • Submitting LMUSI 2.9.2.1 AFN may obtain LMU information and reserve facilities by submitting a mechanized LMU query or a manual LMUSI according to the terms and conditions as described in the LMU CLEC Information Package, incorporated herein by reference as it may be amended from time to time. The CLEC Information Package is located at the “CLEC UNE Product” Web site address: xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx/xxxxxx/xxxx/xxxx.xxxx. After obtaining the Loop information from the mechanized LMU process, if AFN needs further Loop information in order to determine Loop service capability, AFN may initiate a separate Manual SI for a separate NRC as set forth in Exhibit A.

  • Pharmacy Benefits - Prescription Drugs and Diabetic Equipment or Supplies from a Pharmacy This plan covers prescription drugs listed on our formulary and diabetic equipment or supplies bought from a pharmacy as a pharmacy benefit. These benefits are administered by our Pharmacy Benefit Manager (PBM). Our formulary includes a tiered copayment structure and indicates that certain prescription drugs require preauthorization. If a prescription drug is not on our formulary, it is not covered. For specific coverage information or a copy of the most current formulary, please visit our website or call our Customer Service Department. Prescription drugs and diabetic equipment or supplies are covered when dispensed using the following guidelines: • the prescription must be medically necessary, consistent with the physician’s diagnosis, ordered by a physician whose license allows him or her to order it, filled at a pharmacy whose license allows such a prescription to be filled, and filled according to state and federal laws; • the prescription must consist of legend drugs that require a physician’s prescription under law, or compound medications made up of at least one legend drug requiring a physician’s prescription under law; • the prescription must be dispensed at the proper place of service as determined by our Pharmacy and Therapeutics Committee. For example, certain prescription drugs may only be covered when obtained from a specialty pharmacy; and • the prescription is limited to the quantities authorized by your physician not to exceed the quantity listed in the Summary of Pharmacy Benefits. Prescription drugs are subject to the benefit limits and the amount you pay shown in the Summary of Pharmacy Benefits.

  • How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!