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 a timely review. Missing information may delay reviewing of the bill.
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.
