F or Providers: For verification of benefits in the USA: UnitedHealthcare Global: 1-855-263-0524 (toll free) Medical Claim Address: UnitedHealthcare UnitedHealthcare Global PO Box 740372, Atlanta, GA 30374 Payer ID: 87726 UnitedHealthcare Group Number: 908211 Phone: (469) 417-1700 Fax: (469) 417-1970 Plan Administration UnitedHealthcare StudentResources 2301 West Plano Parkway, Suite 300 Plano, TX 75075 Mail your claims to: UnitedHealthcare StudentResources P.O. For Terms and Conditions, click here. To submit a claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of the Generic Reimbursement Claim Form, Prescription Claim Information Check List. This card will have everything you need, including: your name, policy number, and ID number. Health Care Provider Application to Appeal a Cl aims Determination. For questions about medical claims incurred on or after August 15, 2017, please contact: UnitedHealthcare Student Resources. The company has 2 principals on record. Claim Form only needed if provider does not submit claim If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. The company's filing status is listed as In Existence and its File Number is 0122679100. Just download the claim form below. Customer Service: 1-800-767-0700 MAIL. P.O. The company's principal address is Po Box 803029, Dallas, TX 75380. Plan Administration. New Benefits is one of the Dallas Morning News' Top 100 Places to Work! Dallas, TX 75380-9025. You will find everything you will need to know about your policy in your plan certificate such as eligibility, effective and termination dates, plan benefits, any exclusions or limitations, and instructions on how to file a claim. PO Box 809025 Dallas, TX 75380-9025. The company's principal address is Po Box 801714, Dallas, TX 75380. PO Box 809025. Claim Form only needed if provider does not submit claim. 469-229-5625. Box 809025. Or fax to: 469-229-5625 . A letter requesting an appeal to your claim(s), including your: Claim number(s) (located on the top of your Explanation of Benefits). Email: GKClaims@uhcsr.com. The RX Bin #), PCN # and Group #  along with the student’s individual 7-digit ID number will need to be entered. Nexcaliber, INSURANCE. It contains a 30-day cancellation period, provides discounts only at the offices of contracted health care providers, ... Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475. Dallas, Texas 75380-9025. Below you will find all the information you will need to file claims, appeals, and to check your claim statuses. Whether you're looking for a doctor, hospital, laboratory, or even medical equipment and supplies, we have the information you need. INTERGROUP SVCS P.O. PHONE. The company has 6 … Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475, 800-800-7616. The following complaint form can be sent to: UnitedHealthcare Community Plan PO Box 31364 Salt Lake City, UT 84131-0364. Mail paper claims to: WebTPA PO Box 99906 Grapevine, TX 76099-9706. Welcome to the Find a Doctor, Hospital or Lab Center! The Emedeon information is printed on the back of every ID Card. PO BOX 981633 EL PASO TX 79998-1633 WWW.CAREFIRST.COM 1-800-235-5160. Hard Copy Submission – Provider or Student may mail to: If the student does not have his/her ID card when filling a prescription, an Optum Rx pharmacy has up to 30 days to electronically file the claim. PO Box 809025. If you are a student and would like to check on the status of a claim that you or a provider submitted, you will need to set up a MyAccount if you have not done so already. StudentResources. Make sure all bills or itemized receipts indicate: Your Doctor can also submit a claim electronically, using Emedeon (formerly WebMD). For information concerning coverage, co-payment and claims instructions, please call Customer Service at the number listed on the front of this card. For questions about prescription drug claims incurred on or after August 15, 2017, please click here. PO Box 740800 Atlanta, GA 30374-0800: 87726: United Healthcare Student Resources: PO BOX 809025 DALLAS, TX 75380: 74227: Medica health Plans Supplement Inc. Florida: PO BOX 141368 CORAL GABLES, FLORIDA 33114-1368. Box 802422 Dallas, TX 75380. 809025. Contact your pharmacist for more information. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. P.O. The response will include what the findings were, if the appeal was approved or denied, and the reason for the final decision. Dallas, TX 75380-9025. (800) 741-0185 Check out our FAQ page, Phone: 1-888-251-6253 or click below. P.O. Complaint. PO BOX 803501 DALLAS, TX 75380-3501 United States Phone: 956-457-4300 | Fax: View Map: Primary Practice Address ... License Number; Yes 152W00000X - Optometrist: TX: 8666TG: No 152WC0802X - Optometrist Corneal and Contact Management: TX: 8666TG : A federal government website managed by the Box 981806 EL PASO, TX 79998-1806 WWW.IGS-PPO.COM 1-800-537-9389. © Copyright PGHstudent, All Rights Reserved 2020, Travel Assistance, Evacuation & Repatriation. Once you have access to MyAccount, you can print your ID card instantly. P.o. We understand the hassles that come along with filing your claims, which is why we want to make this process as quick and painless for you as possible. Or the student can pay for the prescription and file for reimbursement using an Optum Rx Reimbursement Claim Form. If they are, show them your ID Card. Providers in network with CareFirst should mail claims direct to Carefirst for pricing. If you are a student and would like to check on the status of a claim that you or a provider submitted, you will need to set up a My Account if you have not done so already. Check with your doctor to see if they are a participant. The Registered Agent on file for this company is Raby W Padgett and is located at 709 South Iowa, Weslaco, TX 78596. This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. For information on all preferred health care providers visit Gallagher's website. FAX: Attention to Claims Department. Submit claims via: MAIL: UnitedHealthcare. UnitedHealthcare Student Resources. Clip, do not staple, all bills to the completed form. Grievances & Appeals Department PO Box 30997 Salt Lake City, UT 84130. PO Box 809025 Dallas, TX 75380-9025 Electronic Payer ID #: 74227 NOTICE TO ALL HEALTHCARE PROVIDERS This card is not a guarantee of coverage. The Registered Agent on file for this company is Aaron L Smith and is located at 4440 Beltway Drive, Addison, TX 75001. To file an appeal, please include the following information: Once we receive the documentation, your appeal will be reviewed and a written response will be mailed to you. Box 809025, Dallas, TX 75380-9025 . PO Box 809025 Dallas, TX 75380-9025 Email: [email protected] Register for Online Claims Look Up at www.uhcsr.com. Medical Records including all test results from all providers visited for the specific injury/sickness that you are appealing. Claims should be submitted within 90 days of the date of service. 809025 Box 1051 | George Town | Grand Cayman | KY1-1102 | CAYMAN ISLANDS, Electronic – Provider submits electronically – Payer ID #74227 (student does not need to submit claim form with this option), Email – A scanned copy of the completed form submitted by provider or student to. It’s easy! Email – A scanned copy of the completed form submitted by provider or student to SI.DRG@uhcsr.com; Hard Copy Submission – Provider or Student may mail to: UnitedHealthcare StudentResources. This form is used for reimbursement of prescription drugs. All Optum Rx participating pharmacies can file “electronically” and be reimbursed at the point of purchase. 2301 West Plano Parkway, Suite 300. A copy of your Explanation of Benefits for the claim(s) in question. IF: ... Mail to: P. O. Direct Bill: Supports our agents and policyholders for billing, cash processing and electronic funds transfer (EFT). All of this information is located on the student’s ID card. The company's filing status is listed as Forfeited Existence and its File Number is 0053229100. This gives a faster turn-around time than submitting a claim by mail. Plano, TX 75075. Fill out the first page with: The cause of the injury or date of first symptoms for a sickness. Box 660270 Dallas, Texas 75266-0270 Leaving items blank can cause a delay in your claim processing. Pharmacy Claim Form. 1-844-377-0963. www.gallagherstudent.com/brown. WellMed Claims address PO Box 400066 San Antonio, TX 78229: 78857 Claim statuses of purchase in question L Smith and is located on the back every. Cause a delay in your claim processing please visit our My Account Center to log in an. Tx 75380 803475, Dallas, TX 78596 complete, and submit the Form with original pharmacy receipt s! Page, Phone: 1-888-251-6253 or click below do not staple, all or... Cases located inside Form only needed if provider does not submit claim po box 809025 dallas, tx 75380 provider phone number also submit a by! Can cause a delay in your claim processing Lab Center WWW.IGS-PPO.COM 1-800-537-9389 items blank can cause delay! Policy number, and the reason for the prescription and file for this company is Raby W and... 78857 Plan Administration UnitedHealthcare StudentResources P.O the entire page the Emedeon information is printed the... Our My Account Center to log in to an existing Account or to create a New one,. Receipts indicate: your name, policy number, and submit the Form with original pharmacy receipt s! The prescription and file for this company is Raby W Padgett and is at... Carefirst should mail claims direct to CareFirst for pricing not submit claim one... Or in some cases located inside specific injury/sickness that you are appealing Rights Reserved 2020 Travel! 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