Bills and receipts should be itemized and show: For long or continuing inpatient stays, or other long-term care, you should submit claims at least every 30 days. Use a separate claim form for each family member. When you must file a claim – such as when another group health plan is primary – submit it on the CMS-1500 or a claim form that includes the information shown below. Your facility will file on the UB-04 form. Your provider must file on the CMS-1500, Health Insurance Claim Form. Just present your ID card when you receive services. To obtain claim forms or other claims filing advice, or answers to your questions about our benefits, contact us at the customer service phone number on the back of your ID card, or at our website at In most cases, physicians and facilities file claims for you. See Section 3 for information on pre-service claims procedures (services, drugs, or supplies requiring precertification or prior approval), including urgent care claims procedures. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.This Section primarily deals with post-service claims (claims for services, drugs, or supplies you have already received). It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. It is believed to be accurate at the time of posting and is subject to change. This content is being provided as an informational tool. The form linked below should be completed by a member who needs to grant access to their PHI to another individual in connection with an appeal. The form linked below should used by a member who would like to grant permission to another individual to act on their behalf in connection with an appeal. Please note, the claims appeal procedure is explained at length within each group’s Summary Plan Description (SPD). Submission of these forms to the Meritain Health Appeals Department without a formal written appeal from the provider will not be reviewed. The formal written appeal and these forms would then be sent to the address of the Meritain Health Appeals Department (listed on form) by the provider. There are two forms listed below that a member must complete and give to the provider submitting the formal written appeal. Once we receive the request form, the request for external review will be handled in accordance with federal law and/or state law, depending upon the benefit plan. Meritain Health requires the member to complete an appeals form to indicate a request for external review.
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