WebSubmit Great-West Healthcare-Cigna(GWH-Cigna) claims directly to GWH-Cigna at the claims address on the member's ID card: PO Box 188061, Chattanooga, TN 37422 … WebThe Great-west Life Assurance Company is a corporation in Greenwood Village, Colorado. The employer identification number (EIN) for The Great-west Life Assurance …

GREAT-WEST TRUST COMPANY, LLC Employer Identification Number …

Webto The Great-West Life Assurance Company. 1. General. Plan number: Division number: Enrolment Plan sponsor: ... • Great-West Life to use my social insurance number for tax reporting purposes and as an identification number where it is required in the administration of the plan; • Great-West Life, any healthcare provider, my plan ... WebPlan Member ID Number: Patient Name: – (please print) If Yes, a) indicate start date (DD/MM/YYYY): b) coverage provided by: (if coverage is not provided by Great-West Life please provide pharmacy print-out showing purchase of this drug) If Yes, name of other insurance company: If other plan is with Great-West Life, tell us the plan and ID number: cynthia feliks

CLAIM.MD Payer Information GreatWest Healthcare

WebFirst Name Middle Initial Last Name Great-West Life ID Number Division Class If plan is taxable provide Date of Birth (MM/DD/YY) ... A Great-West Life claim representative may contact you to discuss further. Employee’s province of employment: Year-to-date CPP / QPP Contributions: Year-to-date EI Premiums: Year-to-date QPIP Premiums: ... WebSubmit Great-West Healthcare-Cigna(GWH-Cigna) claims directly to GWH-Cigna at the claims address on the member's ID card: PO Box 188061, Chattanooga, TN 37422-8061. Submit electronic claims with payer … WebGreat-West Healthcare company, you are an out-of-network health care professional for patients with a Cigna ID card. 832193 d 05/12 THN-2012-133 Offered by Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Name A Doe CIGNA HealthandLife InsuranceCompany Group00699999 Issuer (80840) ID … cynthia felice