Beacon health options claim form 2026

1. Click ‘Get Form’ to open the beacon health options claim form in the editor.
2. Begin with Section I: Subscriber Information. Enter the Subscriber Name and Subscriber ID as found on your insurance card.
3. Proceed to Section II: Member Information. Fill in the Member Name, Date of Birth, Member ID, and contact details including Street Address and Telephone Number.
4. In Section III: Provider Information, seek assistance from your healthcare provider to complete this section accurately, including Provider Name and NPI.
5. Move to Section IV: Claim Information. Document each Date of Service along with corresponding Diagnosis Codes and Procedure Codes. Ensure all fields are filled out completely.
6. In Section V: Payment Options, indicate whether payment should be made to the Provider or Member. If it’s for the Member, attach proof of payment.
7. Finally, complete Section VI: Attestation and Signature by signing and dating the form before submission.

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