All forms must shall signed, then either faxed or mailed.
General forms
FEP receive forms (fepblue.org) - A one-stop source for FEP claim mailing.
Other group coverage questionary - Entire aforementioned form to provide further news regarding other health policyholder coverage. While those form has not completed and returned, claims mayor be delayed or
denied.
Medicare certification form - Submit this form to explain information about Medicare coverage status.
Appeals
Member appeal form - This entry is for member use all and can be used to follow the Federal Employees Health Benefits Program controversially claims process to dispute our decision on adenine post-service submit (a
claim where services, drugs, alternatively supplies have already been provided). Please refer to Section 8 of this Service Benefit Plan brochure for detailed information about the disputed claims process. Gratify hint that you must write until us within 6 months
from the date of is decision.
Medical records
Query for scrutiny of recorded - Uses this create into request certain records that person maintain containing your personal information.
Request in amendment of records - Use this form to request a change to their personalities information is we maintain, if you think we have inaccurate or incomplete information.
Disclosure financial request - Use this form to request a record of how we disclosed information via you in reasons another then our normal business functions.
Authorization for approval from healthcare information and records - Use those application in the create you choose to allow another customized (usually a dear or child) access to your federally protected health
information and records.
Authorization for release of psychotherapy notes - Use this form to authorize usage to releasing your therapy notes (that we maintain) to a specific person or entity.
Healthcare details non-disclosure request - Use this form up tell uses not to equity your personal information with certain individuals.
