Usd claims usdirectexpress 2025

1. Click ‘Get Form’ to open the usd claims usdirectexpress in the editor.
2. Begin by entering the Cardholder’s Name, Date of Birth, and Gender. Ensure that you circle the correct gender option.
3. Input the Cardholder ID Number and check if there is a new address. Fill in the complete address including Street, City/State, and Zip Code.
4. Provide details about the Employer and Insurance Carrier along with the Group Number.
5. In the Patient Information section, list each patient submitting claims. Include their name, relationship to the cardholder, gender, date of birth, and number of prescriptions attached.
6. Complete the Prescription Information section by ensuring all required receipts/labels are included. Tape them securely to a separate piece of paper as instructed.
7. Finally, sign and date the form at the designated area to certify that all information is accurate before submission.

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