Provider Refund Form - BCBSIL
BlueCross BlueShield refund request letter. f) Check Number and Date: Indicate the check number and date you are remitting for this refund. g) Amount: Enter the total amount refunded to BlueCross Blue Shield. h) Remarks/Reason: Indicate the reason as follows: “C.O.B. Credit” Payment has been received under two different Blue Cross
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