First choice claim form 2026

1. Click ‘Get Form’ to open the first choice claim form in the editor.
2. Begin by filling out the MEMBER/PATIENT section. Enter the member's name, address, and indicate if this is a new address. Provide the patient's name, member number, group number, birth date, and relationship to the member.
3. If applicable, complete the OTHER INSURANCE section. Fill in the policyholder’s details and insurance carrier information. Indicate the type of coverage and whether the patient has Medicare benefits.
4. In the PATIENT CONDITION section, describe services provided along with diagnosis codes. If related to an injury, answer questions regarding claims against other parties and attorney representation.
5. Finally, review all entered information for accuracy. Sign and date at the bottom of the form to certify correctness before submission.

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