For immediate assistance, call us toll free at 1-800-878-9399

Thursday, September 09, 2010
Guaranteed Acceptance Health Care Benefits for your clients! Click here for more information.
 
 

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Provider List
 
NOTE: You must have Adobe Acrobat Reader installed on your system to read forms. If you do not have it installed, click the button below to download it.
 

StarCare (Empire) Downloads

Software

Download

SelectXpress Desktop Edition agent Quoting software. The new SelectXpress Desktop Edition allows for the quoting of multiple products and multiple plans, is easier than ever to use, and allows for quicker and easier program updates. This software requires that you use the "update" feature (under Help) at least every 30 days to insure you have the most current rates, information and new products for which you may have been recently appointed.

Additionally, please use the "update" feature as soon as you have installed to make sure you get all products for which you are licensed and the most current

information.

Applications

Download Application for States: TN
Download Application Supplement
Download Authorization For The Release Of Medical Records
Download Request For Rewrite of Existing Health Insurance Coverage

Brochures

Download 2/05 StarCare Brochure (Optimum & Cost Saver) for The Association Group States: TN

Licensing

Download Commission Supplement
Download Direct Deposit Authorization Form 1/10/06
Download IRS Form W-9
Download New Application for Appointment & Assignment of Commissions
Download NEW Application for Appointment & Producer Agreement
Download New Appointment Checklist

Miscellaneous

Download Authorization to Disclose Protected Health Information
Download Employers Acceptance of Payroll Deduction Plan (List Bill Forms ASIM-PDP-1-3 10/06)
Download Express Scripts 2006 Drug Formulary List
Download Express Scripts Pharmacies By State
Download HIPAA Eligibility Questionnaire
Download IAC PreScreen Form
Download Quick Reference Guide (Formerly the Field Underwriting Guide) 
Download Quick Reference Guide Insert - StarCare
Download Risk Assessment Guide: Comprehensive Risk Assessment Guide
Download Select Fax Application Cover Sheet
Download Select Fax Instructions
Download StarCare Rate Calculation Worksheet 11/06 
Download Third Party Payor Plan Form and Patrons Statement of Eligibility & Authorization for 3rd Party Billing Form
Download Web Site Guide

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Bay Insurance Marketing, Inc.

Mailing Address P.O. Box 1575 | Palm Harbor, FL 34682
Street Address 3607 Alt U.S. 19 No. | Palm Harbor, FL 34683

(800) 878-9399 • (800) 878-9467 (fax)


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