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CLAIM FORM FOR MEDICAL DEVICES - providerConnect

WebGREEN SHIELD NUMBER. DATE OF BIRTH (YY/MM/DD) / / SURNAME FIRST NAME. ADDRESS. CITY. PROVINCE. POSTAL CODE. EMAIL. PROVIDER INFORMATION . PROVIDER NUMBER. PROVIDER PHONE # ... If other coverage is with Green Shield Canada, indicate other Green Shield Canada ID Number: Do you want to coordinate … WebSubmit claims, check claim status and filter your claim history, download personalized claim forms, find providers who submit claims for you, and sign up for direct deposit. Read detailed benefit booklets, check coverage eligibility instantly, and check your health care spending account (HCSA) or Personal Spending Account (PSA) balances (if ... church in augusta wv

Please use one form per practitioner, per patient

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