What do I need to submit a medical expense form?
Update:
With the new bill submission tool, you can now submit, track, and stay updated—all in one convenient place: your Member Center.
Here’s what you can do:
Submit new medical bills directly through the tool
Track the status of all submissions at a glance
Receive and review alerts if additional information is needed
Access past submissions through the legacy view (available for a limited time)
Getting started is easy—just log in and scroll to “My Medical Bills".
Here is an article that goes step-by-step on how to use the new Bill Submission Tool.
You can complete your medical expense form online here.
Completing a medical expense form requires detailed information. Please provide as much as you can to ensure timely processing. Missing information may delay processing.
If you are completing this for your medical provider, one of the most important things to include is the ICD-10 Diagnostic code, or you can just ask your provider for the CMS1500/HCFA form or UB04 form to submit on their behalf. If you have any questions, please reach out to Member Services at 855-378-6777.
Not sure where to find the information required?
If you have a form that looks like this red form, please just attach it to your request. It will have all the information we need.
