WebGREEN SHIELD CANADA CLAIM SUBMISSION INSTRUCTIONS Please call our Customer Service Centre at 1-844-997-9888 if you require any assistance in completing … WebGENERAL CLAIM SUBMISSION FORM SECTION 1 - PLAN MEMBER INFORMATION GREEN SHIELD CANADA ID NUMBER EMAIL ADDRESS SURNAME FIRST NAME …
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WebClick on the following links to download claim forms: Green Shield General Claim Submission Form Green Shield Vision Claim Form (eye test & glasses) Green Shield … WebGREEN SHIELD PROVIDER NO. OF PRACTITIONER PROVIDER PHONE NO. GREEN SHIELD PATIENT # COMPANY NAME PLEASE NOTE: This claim form cannot be used for supplies of any type, only services or treatments. Please use one form per practi tioner, as well as per patient. DEP # POSTAL CODE GREEN SHIELD PROVIDER NO. OF … opel grandland electric
GENERAL CLAIM SUBMISSION FORM - Green Shield …
Webattached to the completed authorization form. Preferred Pharmacy Network (PPN) Depending on your benefit plan, you may be required to obtain your special authorization drug at an approved pharmacy if your claim is approved. If this applies to your benefit plan, a Care Coordinator working on behalf of Green Shield Canada. 1. will contact WebOnce completed, submit the form to Green Shield Canada (GSC) via your method of choice: By email: [email protected] . By fax: 1.866.797.6483 . By mail: Green Shield Canada, Drug Special Authorization Department . P.O. Box 1606, Windsor ON N9A 6W1 . Note that submission of an incomplete form may result in delays. WebThe pharmacy will receive a message indicating that the drug must be authorized. The pharmacy can then print the appropriate form (s) that corresponds to the special authorization drug. This form must be given to the plan member to be completed by their physician and returned to Green Shield Canada for assessment. iowa gym rats queens of the court