Anthem Blue Cross Insurance Form For Reimbursement

Complete a fitness center member verification fcmv form.

Anthem blue cross insurance form for reimbursement. Secure employer access to claims. Anthem life compassi. If your pharmacy is willing to accept assignment do not complete this form. Anthem life resources anthem life resources.

Anthem blue cross is the trade name of blue cross of california. A new fcmv form will need to be completed each year or when you attend a new f tness center. In the event of an erroneous or excess reimbursement i understand i am required to reimburse the plan for the improperly paid amount. To download the form.

Independent licensee of the blue cross association. Browse commonly requested forms to find and download the one you need for various topics including pharmacy enrollment claims and more. If claims are submitted out of order anthem blue cross and blue shield anthem will provide a one time reallocation at the end of the run out period. By completing this form i recognize that reimbursement will be paid directly to me and that assignment of these benefits to a pharmacy or any other party is void x.

I certify that to the best of my knowledge the information on this member claim form is true and correct. Signature of member date if allowed by law you may assign the payment of this claim to your pharmacy. How to claim your reimbursement to get your reimbursement follow these simple steps. We make our reimbursement policies available to health care professionals as part of anthem s commitment to transparency.