How
to File a Claim
In
most cases, providers and facilities file claims for you.
When
you must file a claim:
- You receive services
outside the United States
- Another group health
plan is primary
- You use an Out-of-Network
provider
Submit sevices on the
HCFA-1500 or a claim form that includes the information shown below:
- Patient's name and
relationship to enrollee;
- Member #;
- Name, address, and
tax identification number of provider or facility;
- Signature of physician
or supplier including degrees or credentials;
- Dates of service;
- Diagnosis (ICD-9 Code);
- Description of service
(CPT/HCPCS Code);
- Charge for each service
or supply; and
- If another group health
plan is primary, send a copy of their explanation of benefits.
Where to File
All medical claims (except when Medicare is the primary payer) should
be submitted to:
CIGNA HealthCare
P.O. Box 5909
Scranton, PA 18505
Mental Health and
Substance Abuse Claims
United Behavioral Health
provides our mental health and substance abuse (MHSA) benefits.
To be eligible to receive enhanced MHSA benefits, treatment must
be preauthorized by calling 1-877-468-1016.
Claims should be submitted
to:
United Behavioral
Health
P O Box 30755
Salt Lake City UT 84130-0755
When Medicare
is the primary payer, and will not cover your services, call the
Plan at 703-729-4677 or 1-888-636-NALC (6252) to obtain benefits.
Claims for
Medicare-primary patients should be submitted to:
NALC Health Benefit Plan
20547 Waverly Court
Ashburn VA 20149
Note: You do not need to preauthorize treatment when Medicare covers
your services.
When
Medicare is Primary
When Original Medicare
is the primary payer, Medicare processes your claim first. Your
copy of the Medicare Summary Notice (MSN) will include a statement
confirming that a secondary claim has been filed with the Plan.
If Medicare is primary, and your MSN does not show this message,
submit a paper claim, including the MSN, to:
NALC Health Benefit
Plan
20547 Waverly Court
Ashburn VA 20149
QUESTIONS?
Call the Plan at 703-729-4677
or 1-888-636-NALC (6252) if you need assistance.
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