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A Corrected Claim Does Not Constitute An Appeal.
For more details, see our corrected, replacement, voided, and secondary claims section. Do not use this form to respond to an additional information request from bcbstx. Submit only one form per patient. A corrected claim is member and claim specific and should only be submitted if the original claim information was incomplete or inaccurate.
Web Choose Your Location To Get Started.
Forms for blue cross blue shield of michigan (ppo) members. Prescription drug claim forms (ppo and hmo) Individual plans medicare advantage plans federal employee program (fep) plans premera hmo appeals claims and billing Claim review (medicare advantage ppo) credentialing/contracting.
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Web provider forms | provider | premera blue cross provider forms browse a wide variety of our most frequently used forms. Forms for blue care network (hmo) members. Web this form is only to be used to make corrections to a previously adjudicated claim when you are unable to submit the corrections electronically. For additional member forms, view our specific plan pages:
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