How do I submit a Medical Expense Form?

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.  

 

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