The company's filing status is listed as In Existence and its File Number is 0122679100. 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. A copy of your Explanation of Benefits for the claim(s) in question. Or fax to: 469-229-5625 . PO BOX 981633 EL PASO TX 79998-1633 WWW.CAREFIRST.COM 1-800-235-5160. Plano, TX 75075. Nexcaliber, INSURANCE. Providers in network with CareFirst should mail claims direct to Carefirst for pricing. The RX Bin #), PCN # and Group #  along with the student’s individual 7-digit ID number will need to be entered. Customer Service: 1-800-767-0700 MAIL. 809025. This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. 1-844-377-0963. www.gallagherstudent.com/brown. PO Box 809025. Please download, complete, and submit the form with original pharmacy receipt(s). Contact your pharmacist for more information. For information concerning coverage, co-payment and claims instructions, please call Customer Service at the number listed on the front of this card. StudentResources. 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. Plan Administration UnitedHealthcare StudentResources 2301 West Plano Parkway, Suite 300 Plano, TX 75075 Mail your claims to: UnitedHealthcare StudentResources P.O. The Registered Agent on file for this company is Aaron L Smith and is located at 4440 Beltway Drive, Addison, TX 75001. Pharmacy Claim Form. Once you have access to MyAccount, you can print your ID card instantly. 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. The company's filing status is listed as Forfeited Existence and its File Number is 0053229100. The company has 2 principals on record. FAX: Attention to Claims Department. 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 response will include what the findings were, if the appeal was approved or denied, and the reason for the final decision. Plan Administration. Dallas, Texas 75380-9025. Health Care Provider Application to Appeal a Cl aims Determination. Email: GKClaims@uhcsr.com. Mail your claims to: UnitedHealthcare Student Resources. The Registered Agent on file for this company is Raby W Padgett and is located at 709 South Iowa, Weslaco, TX 78596. Claim Form only needed if provider does not submit claim. P.O. P.O. Claims should be submitted within 90 days of the date of service. Please visit our My Account Center to log in to an existing account or to create a new one. Make sure all bills or itemized receipts indicate: Your Doctor can also submit a claim electronically, using Emedeon (formerly WebMD). 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. A letter requesting an appeal to your claim(s), including your: Claim number(s) (located on the top of your Explanation of Benefits). Copyright 2017 SHIP, Ltd. | P.O. PO Box 809025. Medical Records including all test results from all providers visited for the specific injury/sickness that you are appealing. It’s easy! 809025 Below you will find all the information you will need to file claims, appeals, and to check your claim statuses. 2301 West Plano Parkway, Suite 300. The following complaint form can be sent to: UnitedHealthcare Community Plan PO Box 31364 Salt Lake City, UT 84131-0364. P.o. INTERGROUP SVCS P.O. 469-229-5625. For questions about medical claims incurred on or after August 15, 2017, please contact: UnitedHealthcare Student Resources. This form is used for reimbursement of prescription drugs. Box 802422 Dallas, TX 75380. PO Box 809025 Dallas, TX 75380-9025 Electronic Payer ID #: 74227 NOTICE TO ALL HEALTHCARE PROVIDERS This card is not a guarantee of coverage. 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. The company's principal address is Po Box 801714, Dallas, TX 75380. IF: ... Mail to: P. O. © Copyright PGHstudent, All Rights Reserved 2020, Travel Assistance, Evacuation & Repatriation. PO Box 809025 Dallas, TX 75380-9025. Mail paper claims to: WebTPA PO Box 99906 Grapevine, TX 76099-9706. For information on all preferred health care providers visit Gallagher's website.

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