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Forms and Resources

Forms and Resources

Forms & Resources for Guests

Sure Pay Authorization Form:

Rates:

Claims:

Provider Appeal and Grievance Quick Reference Guide [PDF]
Corrected Claims Information [PDF]

Receiving Care While Away From Home:

For PPO Members [PDF]
For HMO (BlueSelect) Members [PDF]

Privacy:

BCBSAZ Confidential Information Release Form [PDF] Español [PDF]
BCBSAZ Confidential Information Release Form for HIV Related Information [PDF]
HIPAA Notice of Privacy Practices [PDF]

Commission/Compensation:

Sales Compensation Information [PDF]

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