regence claims address

Mail this claim to: Regence BlueShieldPO Box 1106Lewiston, Idaho 83501 Or Fax claim to: (888) 606-6582 FORM PD020-WA Page 2 of 3 (Eff. DJT BCBS Minnesota hbbe`b``3 1x0@ t I Professional Services are performed by a doctor or other healthcare professional. ABI BCBS Minnesota Once you have signed in, simply click on the Claim Search link. Illinois. Regence Blue Shield in accordance with the terms of your provider contract with Regence. You have five UMP medical plan options: UMP Classic. CWH Anthem Blue Cross of California Filing your claims should be simple. The main identifier for out-of-area members is the alpha prefix. Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days from the date of submission. Prefixes with * include all characters for the 3rd position unless otherwise . We're ready. ** Blank, or empty suitcase logo. Please To pay this claim, we needed to review information from the provider. CUU BCBS of Texas Click on the Submit a Preauthorization Request link. Oregon Providers (non-contracted and contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 12 percent annual rate on the unpaid or un-denied clean claim. Both for dental and medical professional services, promises forms can be found. Asthma. A Level I Appeal is used to dispute one of our actions. This procedure is considered cosmetic. This prefix is the part of the distinctive identification number. To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). account number and claim number handy when you call. These ID cards also will contain three-character alpha prefixes. AHW BCBS of MA You have 365 calendar days to submit a complaint following the action that prompted the complaint. The main identifier for out-of-area members is the alpha prefix. Where do I submit a preauthorization request? ABW Anthem BCBS of Virginia The alpha prefix identifies the Blue Plan or National Account to which the member belongs. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. When we are the primary carrier, we calculate and pay benefits routinely. AGG Anthem BCBS of Ohio UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees. We are unable to quote a benefit by a diagnosis or procedurecode. We haven't received the information. Prefix Product Area Billing Address Phone #, AAX CA BC CA, POB 60007 , Los Angeles , CA , 90060 800-765-2588, ABW VA BC VA, Trigon POB 27401, Richmond , VA , 23279 800-445-7490, ACN PA BC PA, Highmark BC PO Box 1210 , Pittsburgh , PA , 15230 800-682-3386, ACT NY BCBS Empire, POB 11800 , Albany , NY , 12211-0800 800-992-2583 ACR Anthem Blue Cross of California ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. CZX Anthem BCBS of Ohio Phone: 844-380-8838, 800-863-5488 (TTY) Here are common reasons why claims suspend or reject: Contact Customer Service with questions regarding claims processing or send a copy of the voucher highlighting the claim in question and the inquiry reason. For most plans, we'll deny claims received more than 12 months after the date of service with no member responsibility. Ting Vit | We may send a questionnaire to the member regarding possible duplicate coverage. Retirees and PEBB Continuation Coverage members:Phone: 1 (800) 200-1004TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). QMF Retail ON Exchange ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. 0000006371 00000 n QAA. The IQ is available in the Provider Library under Forms. ADY BCBS of South Carolina Its often confused that BCBS have lot of prefixes and where to contact. The protection of your privacy will be governed by the privacy policy of that site. Regence BlueShield in accordance with the terms of your Provider contract with Regence. If you are interested in purchasing a new computer system, ask us for a list of vendors that submit claims to us in the HIPAA standard ANSI 837 format. This service is considered a standard exclusion. Find Contact Information. Anthem Blue-Cross Blue-Shield of Colorado. A subrogation provision is included in both member and physician/provider contracts. Visit the Regence provider website, regence.com to learn more about: Claims and payment: Appeals. Provider: send us the NDC #, quantity and date span for this claim. claim and apply additional edits if applicable. This is a claim adjustment of a previously processed claim. If you are not registered, please click on the Not Registered link to set up your account. RGA observes theholiday schedule below. Provider: send us medical records relating to prescription drug charges. 4. These weights are then multiplied by the dollar conversion factor we publish. Payment of this claim depended on our review of information from the provider. Physicians and providers may submit a proposal to modify a payment policy. YDO Retail OFF Exchange Deutsch | DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. Calypso, our affiliate, processes refunds and overpayment requests. Be on . Correspondence. View the toolkit Claims submission BCBS Provider Phone Number. Phoenix, AZ 85072, Retail Pharmacy Program CZM Highmark BCBS CVS Caremark. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. You will need special software to send insurance claims electronically. DJY Anthem BCBS of Ohio CZU Anthem Blue Cross of California We accept electronic claims through Availity using payer ID RGA01. When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. If we do not receive a response within the specified period, the claim(s) is denied pending further information. AGV BCBS of MA Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. Claims It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. Our Customer Care lines will re-open at 6 AM PT the following business day. %%EOF You can learn more about credentialing by visiting the provider section of our website. 0000014071 00000 n Professional example: GENERAL CLINIC is the provider of service. AAY Wellmark BCBS Iowa/South Dakota ACA BCBS of Alabama Blue-Cross Blue-Shield of Illinois. AAU Blue Shield of California Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. Please provide a detailed description of the service for preauthorization to a member of our Customer Care Team at 1-866-738-3924 and they will let you know if the service requires preauthorization. Box 7408. ** A local network identifier, (for example, BlueMark) 0000006620 00000 n AHJ Independence Blue Cross 10700 Northup Way, Suite 100 We follow industry standard coding recommendations and guidelines from sources such as the CMS, CPT, and AMA, and other professional organizations and medical societies and colleges. Portugus | On the Availity Web Portal, you can: Run transactions to obtain member benefit, eligibility and claims information. Provider: please send us your operative notes for this claim. ABL BCBS of IL CVJ BCBS of Florida AHI BCBS of Rhode Island This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. Seattle, WA 98111-9202, Back to Medical Reference Manuals overview, Espaol | When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. See our FAQs for more claim information and contacts. Resource-based relative value scale (RBRVS) Claims adjudication system Claims Editors Payment Policies Payment policies Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. AEC BCBS of IL . QMG SG OFF Exchange. We also apply the following Prompt Pay standards set by the State of Alaska to our claims adjudication process in order to: Oregon contracted and non-contracted Once the submission is complete and if the issue is billing related, we review the request and issue a decision within 30 days, along with your right to submit a Level II Appeal if you are not satisfied with the outcome. An EDI representative will review the test claims with you or your vendor. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. Stay up to date on what's happening from Bonners Ferry to Boise. A detailed description of the disputed issue, All evidence offered by you in support of your position including medical records, A description of the resolution you are requesting. There is no charge to healthcare providers who submit electronic claims directly to us. ADI Anthem Blue Cross of California Lack of credentialing can be grounds for termination from Premeras network. Once the IQ is returned, all claims are reviewed and processed based on the information supplied. If we cannot resolve the matter through non-binding mediation, either one of us may institute an action in any Superior Court of competent jurisdiction. A Level I Appeal is used for both billing and non-billing issues. Portugus | color, national origin, age, disability, sex, gender identity, or sexual orientation. Thank you for the care you provide to our members and people in our communities. %PDF-1.4 % Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. DJJ Horizon BCBS of New Jersey AGF Anthem BCBS of Ohio BCBS Provider Phone Number. CZW BCBS of North Carolina Heres everything you need to know about it. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. Blue-Cross Blue-Shield of Tennessee. Supplier Registration Costco Mail-Order PharmacyOnline: Sign in to your Costco accountPhone: 1 (800) 607-6861TRS: 711Fax: 1 (800) 633-0334Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific)Note: UMP members do not need to be Costco members to use their mail-order service. ID cards for the following products and programs do not have an alpha prefix: ** Stand-alone vision and pharmacy when delivered through an intermediary model*, ** The BCBS Federal Employee Program (FEP) The letter R appears in front of the ID number.*. CVA Anthem BCBS of Ohio Completion of the credentialing process takes 30-60 days. Human Resources Inquiries. We also apply the following Prompt Pay standards set by the Oregon Insurance Division to our claims adjudication process in order to: A clean claim is one that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. | 0000009519 00000 n Ting Vit | In box 22 on the CMS-1500 Claim form, enter the appropriate bill frequency code, left justified in the left hand side of the field. The provider needs to submit itemized charges to us. The plan mailing addresses are available on our website under Contact Us. We use cookies on this website to give you the best experience and measure website usage. You can recognize Managed Care/POS members who are enrolled in out-of-area networks through the member identification card as you do for all other BlueCard members. Tagalog | Plan to submit test claims. It doesn't replace your tax ID number (TIN) or Drug Enforcement Administration (DEA) number. To ensure accurate claim processing, it is critical to capture all ID card data. Pay clean claims within 30 days of receipt; and, Pay unclean claims within 15 days after receipt of information, Pay unclean claims within 30 days after receipt of information. Were ready. Regence Blue-Cross Blue-Shield: PDS: Maryland/District of Columbia/Northern Virginia: Carefirst Blue-Cross Blue-Shield: PDT: Pennsylvania: Members and Providers: 1-800-395-1616 Email Us. BJF NCJ YLB YLG YLX BJT RFB YLC YLK YLY EHP SWH YLD YLN YLZ MES YLA YLE YLW, Network Name Old Alpha Prefix New Alpha Prefix, YDQ Retail ON Exchange CVK BCBS of Florida You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Invalid claims are reported back to the provider with rejection details. When a member is the subscriber on more than one plan, when both plans have a COB provision, the plan with the earliest start date pays first (primary). Please reach out and we would do the investigation and remove the article. Mental Health/Substance Use Disorder Precertification. 0000004968 00000 n Payments are issued under a separate voucher and mailed to the address on the original claim. Regence BlueShield. DJK Empire BCBS AEF BCBS of IL Provider Contact Center. AAQ Anthem BCBS of Ohio Remember to include the leading three-character prefix and enter it in the appropriate field on the claim form. AEZ Wellmark BCBS Iowa/South Dakota Polski | Online Claim Submission. Karen Lyons, APR Sr. Director, Public Relations 612.777.5742 klyons@primetherapeutics.com. To ensure that OCR reads your paper claims accurately: Submitting a corrected claim may be necessary when the original claim was submitted with incomplete information (e.g., procedure code, date of service, diagnosis code). Get help when you need it. Eligibility, enrollment, and address/name changes. Identifying members Easily identify the kind of coverage our members have. From there, you will be directed to a new site; at this site, enter in your login information. LAB. ABQ Blue Cross of Idaho (Boise) Guardian Employees . Care Management Programs. Regence health plans operate in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable. TINs are still a required element for claims. 0000008643 00000 n Bill all original lines-not including all of the original lines will cause the claim to be rejected. If there is no alpha prefix, do not create one or use an alpha prefix from another members ID card, even one from the same BCBS Plan. Fax: 801-333-6523 (Mark claims: Attn New Claims) Email: Log in or register - MyBlue Customer eService. TRS: 711 Fax: 1 (800) 633-0334 Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific) Note: UMP members do not need to be Costco members to use their mail-order service. AES BCBS of Alabama AIJ Empire BCBS PO Box 33932 Seattle, WA 98133-0932 Phone: 800-562-1011 6:00 AM - 5:00 PM AST Fax: 877-239-3390 (Claims and Customer Service) Fax: 877-202-3149 (Member Appeals only) Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests) Email Members: Log in or register - MyBlue Customer eService Retail pharmacy services Claims DJM BCBS of Texas EMPIRE BCBS Decides the pre certification requirements based on the prefix id. ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. The Identification cards will include: ** The three-character alpha prefix at the beginning of the members ID number Use search function and put your comment any alpha prefix not found here. Claims. Here are examples: A Level I Appeal must be submitted with complete supporting documentation that includes all of the following: Incomplete appeal submissions are returned to the sender with a letter requesting information for review. Review our pricing disputes and appeals information to ensure you are following the correct process. Call Customer Service and choose the Pharmacy option. AGH Anthem Blue Cross of California AAN Anthem Blue Cross of California ** Verify with the member that the ID number on the card is not his/her Social Security Number. Is there any way that I can download the contact# with prefix. ADA Anthem Blue Cross of California ), Charges billed by physician/provider at a line item level, Amount allowed for service at a line item level, Adjudication explanation code(s) at a line item level and claim level (if applicable), Printed at the end of each claim, the line items are summed and an asterisk indicates the claim total line, Less Paid to Codes Listed as S or C, The sum of the claim total Payable Amounts which have a PD TO code of S or C, The sum of any amount withheld and applied to a prior refund or recovery. VOG NY MA PPO MediBlue PPO Plus 1-866-395-5175 H3342, Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016, Premera Blue Cross & Premera Blue Cross/NASCO Prefixes. Your account number can be included in box 26 (Patient's Account Number) of the CMS-1500 form whether you submit electronically or on paper. . Franais | BCBS Provider Phone Number. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. Blue Cross and Blue Shield of Illinois P.O. However, there are some exceptions. Units shown in box 24G of the CMS-1500 form. To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. DCL BCBS of TN Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. We can't process this claim because we haven't received your response to our request for information. ABZ Carefirst BCBS Maryland AHO BCBS of Tennessee KingCareSMuses a preferred provider organization (PPO) for its network. Blue Cross and Blue Shield of Illinois P.O. UMP Customer ServicePhone: 1 (888) 849-3681 TRS: 711 Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)Chat Live: Sign in to your Regence account Monday through Friday 7 a.m. to 5 p.m. (Pacific) to access chat live. BCBS Provider Phone Number. AHD BCBS of South Carolina We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. You may have invested in the account specific alpha prefix health insurance plan from BSBS at this time. ** The empty suitcase logo P.O. Need information from the member's other insurance carrier to process claim. Verify eligibility via Highmarks NaviNet. You can also use the Office of Financial Management MyPortal to update your address. You could download the full BCBS prefixes list is here. Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. Refer to your contract for further claims submission information. 0000010231 00000 n Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. | CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. Saturday 7 a.m. to 8 p.m.; Sunday 7 a.m. to 7 p.m. (Pacific)Calling from outside the US: Dial exit code of your country (typically 00) plus the country code (1 for USA), then the area code (916), then the seven-digit US local phone number 635-7373. Facility Services are services received for the use of a facility such as a hospital, emergency room, freestanding ambulatory facility, attended sleep study at outpatient part of a hospital, alcohol treatment facility or residential Centers of Excellence Program administered by Premera Phone: 1 (855) 784-4563 TRS: 711 Business hours: Monday through Friday 7 a.m. to 5 p.m. (Pacific), Puget Sound High Value NetworkPhone: 1 (855) 776-9503TRS: 711Business hours: Monday through Friday 7 a.m. to 7 p.m. (Pacific), UW Medicine Accountable Care NetworkPhone: 1 (888) 402-4237TRS: 711Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). CYQ BCBS of IL Regence BlueShield Attn: UMP ClaimsP.O. trailer 0000055309 00000 n A non-billing issue is classified as a member appeal because the financial liability is that of the member, not the provider (please refer to Chapter 6). If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Open 24 hours a day, 7 days a week. Thank you for choosing Regence as your health plan administrator. The Level I Appeal must be submitted within 365-days following the action that prompted the dispute. <<1CC62891B116FE488EB50D904D0BD9AE>]/Prev 176800/XRefStm 1570>> Need help with a claim? Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. Polski | Provider who rendered the service. Before implement anything please do your own research. Your member ID card is your key to using your medical plan benefits. . CPT 92521,92522,92523,92524 Speech language pathology, CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. CUQ Blue Shield of California 0000008298 00000 n Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . We can't process this claim because we haven't received the necessary information we requested from your provider. Here's everything you . Because your primary doctor and your specialists may all work for different clinics, you may need to do more of your own care coordination. You can find a claim by the members ID number or by the claim number. This review is necessary to determine whether the claim(s) should be covered by a first-party carrier (e.g., PIP, Med Pay or similar coverage - homeowners or a commercial medical premise policy). The total number of characters in the members ID ranges from six to fourteen. The three characters preceding the subscriber identification number on BCBS member ID cards. Caused by another party (e.g., slip and fall, medical malpractice, etc. DJC Anthem BCBS of Ohio All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. CYY Premera Blue Cross of Washington We will notify you once your application has been approved or if additional information is needed. 0000015026 00000 n CUP CBA BLUE (BCBS VT) Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Regence Blue-Cross Blue-Shield: HCT BCBS Prefix: Pennsylvania: Highmark Blue-Cross Blue-Shield of Pennsylvania: HCU: Tennessee: Blue-Cross Blue-Shield of Tennessee: HCV: You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. Please refer to the members ID card to determine if he/she has one of these products. Unclean claims will begin to accrue interest on the 16th day AGB Excellus BCBS CVX BCBS of IL ABY Carefirst BCBS Maryland CZC Anthem BCBS of Ohio Once we accept your level II appeal, we will respond within 15 days in writing or a revised Explanation of Payment. AGS Anthem Blue Cross of California Note that some processing systems may have a limitation regarding the number of characters recognized. AII BCBS of Louisiana Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. They require completion and mailing of an Incident Questionnaire for possible accident investigation or a Workers Compensation injury (claims in subrogation). This member wasn't eligible for services on the date of service. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. ** Empty suitcase logo, for eligible Manage Care/POS, Traditional and Managed Care/HMO members. Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. P.O. An interest check is issued only for months in which the accumulated interest is equal to or greater than the minimum threshold of $25. In this health insurance plan, alpha prefix is assigned to national accounts. If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 2023 Regence BlueShield. CYK BCBS of Georgia The mediator's fees are shared equally between the parties. What do I do if a member has an identification card without an alpha prefix ? Regence Provider Appeal Form. CZB Wellmark BCBS Iowa/South Dakota LAA. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. Washington Contracted Providers: If we fail to satisfy either of the above standards, well pay interest on each claim that took longer than 60 days to process at a 12 percent annual rate (unclean days are not applied toward the 60 day calculation). Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. CWK BCBS of MA CVZ Horizon BCBS of New Jersey COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. the instructions to determine where to send claims or correspondence. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. PO Box 1106. information. Email: Prproviderrelations@bcidaho.com. It is critical for confirming a patients membership and coverage. . AFC BCBS of IL We will send the member an IQ if the claim(s) is potentially accident-related. CYN Highmark BCBS CWB BCBS of Georgia Only appeals received within this period will be accepted for review. 24/7 anonymous hotline: 1 (800) 323-1693 We can process the claim after we receive that information. 0000008944 00000 n 0000018650 00000 n Email: Contact Regence. As a beginner to alpha prefix of BCBS at this time, you like to know about the role of the alpha prefix and how to use this alpha prefix properly. Please provide a detailed description of the service being provided and the code to a member of our Customer Care Team at 1-866-738-3924 and they will provide you with an accurate benefit quote. contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 15 percent annual rate on the unpaid or un-denied clean claim. All Excellus plans use this mailing address: Excellus BCBS Attn: Claims P.O. We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. The National Uniform Claim Committee (NUCC) has developed a 1500 Reference Instruction Manual detailing how to complete the claim form to help nationally standardize how the form is completed. PO Box 52057 0000000016 00000 n Monday-Friday, 8-5 Pacific (800) 552-0635 www.CarpentersBenefits.org.

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