How to File a Claim

Individual Major Medical and Small Business Fully Insured Medical Claims

We require a standard bill for processing claims. A standard bill is completed by your medical provider and includes the date of service, diagnosis code(s), procedure code(s) performed, charge per individual procedure, patient information, and provider information, including their tax identification number.

Medical providers complete a standard 1500 HCFA form for physician claims or a standard UB form for hospital claims. If your medical provider will not send a claim to us, ask if they will give you an itemized bill or a completed standard 1500 HCFA or UB form, so that you can send it to us for processing.

Please be advised we're unable to process balance due statements as they may not describe the service provided in detail. Please see the back of your ID card for the address to submit a standard billing form.

Once a claim is received and processed, we will mail you an explanation of benefits with the claim’s processing determination.