Personal Comp Member Handbook - CareFirst BlueCross BlueShield

Claims, Enrollment Changes & PaymentsIn most cases where care has been rendered by an eligiblenon-participating provider, you will have to reimburse thehealth care provider the difference between the allowedbenefit minus copayments, coinsurance, or penalties andthe provider’s service charge.To obtain claim forms, call Member Services or downloada form from www.carefirst.com. In the “Members &Visitors” section click on “Forms,” then choose “PersonalComp.” (an example appears on page 17)REMEMBER: All bills must be submitted within the yearfollowing the date of service to ensure payment. For thefastest service, we suggest that you submit your claims assoon as possible, rather than accumulating them until theend of the year.Mail completed claim forms to:Please refer to the form on the next page.Section 1 requires subscriber and/patientinformation.Section 2 requires information about the injuries,conditions, diseases or ailments that required theservices and supplies shown on the bills you aresubmitting with this claim form.Section 3 requires information about the injury if it isaccidental.Section 4 asks if the injury is work related.Section 5 asks for Medicare information.Section 6 requires additional information about otherinsurance coverage the patient may have.Section 7 requires the subscriber’s signature.It is important that you complete every section andevery box within each section. If any questions donot apply to your personal situation, write “N/A”(not applicable) in the box as the response to thatquestion. Any missing information will likely delaythe processing of your claim. All questions must beanswered or the claim will be returned.16