Filing a Claim
If you receive care from a network provider, the provider submits claims for you.
If you receive emergency services from an out-of -network provider, you pay the provider in full, and it's your responsibility to submit a claim form to Group Health or have the provider submit one for you. Claim forms are available from Group Health. (See Contact Information.)
When submitting any claim, you need to include your itemized bill. It should show:
-
patient's name;
-
provider's tax ID number;
-
diagnosis or ICD-9 code;
-
date of service/supply; and
-
itemized charges from the provider for the services/supplies received.
You also need to provide:
-
your name (if you're not the patient);
-
your Social Security number (or unique ID number if assigned one by Group Health); and
-
group number (shown on your Group Health ID card and available from Benefits and Retirement Operations).
For prompt payment, submit all claims as soon as possible. Group Health will not pay a claim submitted more than 12 months after the date of service/supply. If you can't meet the 12-month deadline because of circumstances beyond your control, the claim will be considered for payment when accompanied by a written explanation of the circumstances.
|
