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Excellus fap 130e 913 2014 oe form-2025

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The document is a Group Enrollment Form for HealthyBlue, a nonprofit independent licensee of the BlueCross BlueShield Association. It is designed for employers to enroll employees and their dependents in health and dental insurance plans. The form requires detailed information about the group employer, subscriber status, plan selection, reasons for enrollment or changes, subscriber information, dependent information, and cancellation details. It emphasizes the need for clear printing and signatures to process applications.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What state is BCBS Excellus in?

Excellus BlueCross BlueShield, headquartered in Rochester, NY, is part of a $6 billion family of companies that finances and delivers health care services across upstate New York and long term care insurance nationwide.

What is the phone number for Excellus BCBS of New York, NY provider?

Whether you need help enrolling in a health plan, have questions about your bill, or dont know where to start when it comes to coverage, our local team is here to help. Prefer to call? Give our Customer Care team a call at 1-800-234-4781 and they will help you with the support you need.

What is the fax number for BCBS SC prior authorization?

Methods for Requesting Prior Authorization If you do not have an account, request one here. Fax: 813-751-3760 Submit the Preauthorization Request Form along with supporting documentation.

What is the fax number for prior authorization for BCBS CA?

Providers also have the option to use electronic prior authorization, or complete the California standard Prescription Drug Prior Authorization Request Form and fax to (888) 697-8122.

How to appeal an Excellus denial?

Call Customer Service at the phone number listed on your Member Card, or view our Contact Us page for a listing of phone numbers. You may also submit your grievance or request for appeal in writing. See our Contact Us page for the address of your local office.

Are Anthem and Excellus the same?

Anthem, which owns Blues plans in several states, and Excellus (whose parent is Lifetime Healthcare Co.) are separate entities but linked through the Blues network. That system enables Blue Cross and Blue Shield customers to access care anywhere in the country, Becher said.

What is the fax number for Excellus BCBS of New York?

You may send your request in writing to us at: PO Box 546, Buffalo, NY 14201-0546. Or, you may send your request to our fax number at 1-716-843-7860.

What is the fax number for Empire BCBS of New York prior authorization?

.empireblue.com/nymedicaiddoc To prevent delays in processing your prior authorization request, fill out this form in its entirety with all applicable information and fax to Empire BlueCross BlueShield HealthPlus (Empire) at 1-800-964-3627.

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