If a doctor doesn't submit the claim to the carrier automatically (such as out-of-network providers), here is how a claim can be submitted manually to the carrier for reimbursement.
Medical Claim and Prescription Reimbursement Forms
There are generally two types of claim forms: a medical claim form, or a prescription drug reimbursement form. Here's a quick comparison: Medical Claim Form A medical claim fo... Learn more
Here are some tips on manually submitting claim forms to a carrier: Finding The Right Form Determine whether a Medical Claim Form or a Prescription Drug Reimbursement For... Learn more
Subscribers can dispute claims if they believe their carrier has processed a claim incorrectly according the plan's Explanation of Benefits (EOB). The carrier will review the di... Learn more
The Explanation of Benefits (EOB) is a document sent by carriers to provide details on how a claim was processed. Even if the carrier didn't pay anything for the service, subscr... Learn more
Balance Billing for Insurance Claims
In balance billing, the provider bills a subscriber for the difference between the provider’s charge and the allowable amount. For example, if the provider’s charge is $100 ... Learn more
Submitting Claims With Private Exchanges
Employees enrolled in an insurance plan through a private exchange, such as CalChoice, should not submit claims directly to the exchange. Instead, claims should be submitted... Learn more
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