157 0 obj IMPORTANT: Please have your doctor or supplier of medical services complete the reverse of this form or attach a fully itemized bill. 114 0 obj 0000000854 00000 n x3P0 t.C=63E\i\ g3s endobj 46 0 obj endobj endstream Box 853921 Richardson, TX 75085-3921 Fax: 1.763.852.5057 , https://www.health-improve.org/meritain-health-claim-mailing-address/, Health (9 days ago) Web(9 days ago) WebMeritain Health Claims Mailing Address Health (9 days ago) Web (1 days ago) WebHealth Claim Form Complete and send to: Meritain Health P.O. 102 0 obj endobj 0000018652 00000 n <>/Subtype/Form/Type/XObject>>stream H23U0t.=s#0ag Aetna Meritain Health Claims Address 150 0 obj 0000222040 00000 n endobj endobj The following is a description of how to complete the form. <>/Subtype/Form/Type/XObject>>stream <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 552.6 506.76 579.6 528.96]/Subtype/Widget/T(Sex_3)/TU(Sex)/Type/Annot>> 127 0 obj At Meritain Health, our goal is simpletake a creative approach to health care and build industry-leading connections. 0000004995 00000 n endobj We are your Advocates for Healthier Living, and were here to connect you and your family to the care you need, right when you need it. 0000001388 00000 n x x3P0 t.C=63E\i\ g3s endobj 0000075777 00000 n endobj <>/Subtype/Form/Type/XObject>>stream xPpurb & Select Dental and DVH (Dental Only) ** Network by Aetna. 0000078515 00000 n endobj 76 0 obj 0000010062 00000 n endobj endobj 95 0 obj Transition or Continuity of Care (in Spanish). 152 0 obj endstream endobj endstream You can see the specialist you choose without a referral.. 0000195598 00000 n Allow time for your claim to be processed and your reimbursement check to be mailed to you. 37 0 obj xPpurb & Our navigation partnerships and holistic approach to plan design helps support member health journeys. endobj Electronic Claims Address CLAIM STATUS/ PROVIDER RELATIONS Carpenters' Health & Welfare Trust Fund Meritain Health PO Box 853921 Richardson, TX 75085-3921 . <>/Subtype/Form/Type/XObject>>stream 52 0 obj s0G}JbfX^Z@0R ;]Vomm.mu:bq[0iiz=s7^weqE|ZV%%|-%9 <>/Subtype/Form/Type/XObject>>stream 7 0 obj endstream Section 5. endstream Electronic Claims Address CLAIM STATUS/ PROVIDER RELATIONS Carpenters' Health & Welfare Trust Fund Coventry Health Care P.O. 8 0 obj endstream STATUS AND BENEFIT INFORMATION: 1.800.925.2272 Send to: Meritain Health P.O. <>/Subtype/Form/Type/XObject>>stream 39 0 obj endobj Contact Aetna If you havent created an account, click Register at the top right of this page and follow the prompts. endobj 0000244743 00000 n hb``c``ja```01G30323Zq@ [s8cz^TV`8A X/@` u 1 0 obj <>/Subtype/Form/Type/XObject>>stream xPpurb & 51 0 obj 31 0 obj <>/Subtype/Form/Type/XObject>>stream xPpurb & 0000222181 00000 n <>/Subtype/Form/Type/XObject>>stream 116 0 obj /j(0`P k o5pn*P j(H 47 0 obj endobj endstream Sure, youve probably trusted a gut feeling when deciding something. Claims can be submitted for any covered member. endobj 78 0 obj <>/Subtype/Form/Type/XObject>>stream endobj Mississippi Physicians Care Network (MPCN), Presbyterian Select Provider Network (SPN). You can get answers to what you need, around the clock. As a Meritain Health member, per the Federal Government, you are eligible for insurance reimbursement under a qualified plan for FDA-authorized COVID-19 at-home tests purchased on or after January 15. 1 Health and . 91 0 obj <>/Subtype/Form/Type/XObject>>stream The latest from Meritain Health Offering Easy Access to Virtual Mental Well-being Providers April 9, 2023 Today's employees crave support for their emotional and mental well-being. MERITAIN HEALTH - 117 Reviews - 1405 Xenium Ln, Minneapolis, Minnesota - Insurance - Phone Number - Yelp Restaurants Home Services Auto Services Meritain Health 117 reviews Unclaimed Insurance Write a review Add photo Photos & videos See all 7 photos Add photo xPpurb & Enter a name to find & verify an email >>> Rocketreach finds email, phone & social media for 450M+ professionals. 0000221498 00000 n endobj endstream endstream hmo6 <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 124.92 301.56 579.6 323.76]/Subtype/Widget/T(Spouses Employers Address_2)/TU(Spouses Employers Address)/Type/Annot>> <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 4 0 R /Rect[ 208.56 352.32 218.64 362.4]/Subtype/Widget/T(Group)/TU(Group)/Type/Annot>> 0000007217 00000 n N.-BE+!W9wX4]c&OGQ endobj 0000014276 00000 n For ALL claims, this area must be filled in completely. 83 0 obj <>/Subtype/Form/Type/XObject>>stream xPpurb & endstream xPpurb & PDF Claim Submission and Payment Addresses - mbh-eap.com endobj The member whose information is to be released is required to sign the authorization form. If you need help registering or logging in, contact Meritain customer service at 866.761.3018 3. endobj Box 30111 Health (3 days ago) WebAddress: Telephone #: City: State: Zip: Is this a change of address? <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 371.52 575.64 449.16 597.84]/Subtype/Widget/T(Work Telephone)/TU(Work Telephone \( \))/Type/Annot>> <>/Subtype/Form/Type/XObject>>stream <>/Subtype/Form/Type/XObject>>stream 139 0 obj 0000154272 00000 n 0000071487 00000 n endstream 118 0 obj 143 0 obj 2 0 obj 117 0 obj <>/Subtype/Form/Type/XObject>>stream endobj endobj &'ch&^ f:8_k"xpgq#:P641u"A7j|0'gg~Ky%) .x&"!4F">8Y~"ZV2/?+0jmZ{{4|'uF!V x3P0 t.C=3C=3=3 6P(JJ grs endstream xHMef2'oj,Fm'6bCL{@4t./~I2_d>\@+h?Mu(\bu 7FY,Q$jJ HWnF}G(W{_04A>ye $wfI@b3mltGgI4xmjwKfIah8`g4Bp0z'}$O2%. 0000000016 00000 n 0000070996 00000 n endobj endobj %%EOF endstream If youve already registered, we hope youll visit again. Meritain is a division of Prodigy Health Group, the nations largest independent third-party administrator of self-funded health plans.Meritain part of $600M Aetna purchase - Buffalo Business Firstwww.bizjournals.com/buffalo/news/2011/04/28/meritain-Does meritain health require referrals?meritain or call 1-800-847-8361 for a list of network providers. Mail the Claims Form and supporting documents to the address on the Claim Form or on the back of your Member ID Card. endstream endstream endstream endobj startxref 133 0 obj I am very impressed with Meritain Health. 0000263474 00000 n The form linked below should be completed by a member who needs togrant access to their PHIto another individual in connection with an appeal. <>/Subtype/Form/Type/XObject>>stream endstream <>/Subtype/Form/Type/XObject>>stream Box 7796 London, KY 40742 (877) 232 . 43 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 464.16 213.36 579.84 225.24]/Subtype/Widget/T(Address city state zip)/TU(Address \(city, state, zip\))/Type/Annot>> <> Copyright 2023 Meritain Health. <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 278.04 506.76 302.88 528.96]/Subtype/Widget/T(Sex_2)/TU(Sex)/Type/Annot>> 147 0 obj <>/Subtype/Form/Type/XObject>>stream 0000002916 00000 n <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 4 0 R /Rect[ 281.52 238.2 291.6 248.16]/Subtype/Widget/T(undefined_4)/TU(undefined)/Type/Annot>> <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 90.84 75.6 302.88 95.64]/Subtype/Widget/T(Provider to be paid)/TU(Provider to be paid)/Type/Annot>> x3P0 t.C=C=33=aP gos All sections of the form must be complete for the form to be considered. 0000243858 00000 n Provider services - Meritain Health endobj endstream 42 0 obj 148 0 obj 0000153590 00000 n 0000263097 00000 n 72 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 295.68 51.72 476.04 74.28]/Subtype/Widget/T(NPI Number)/TU(NPI Number)/Type/Annot>> Your patients health and your ability to access their information is important to us. <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 359.76 483.36 441.24 505.56]/Subtype/Widget/T(Childs Birthdate)/TU(Childs Birthdate)/Type/Annot>> endstream endobj 26 0 obj<> endobj 27 0 obj<> endobj 28 0 obj<>/ColorSpace<>/Font<>/ProcSet[/PDF/Text/ImageC]/ExtGState<>>> endobj 29 0 obj<> endobj 30 0 obj<> endobj 31 0 obj<> endobj 32 0 obj[/ICCBased 38 0 R] endobj 33 0 obj<> endobj 34 0 obj<> endobj 35 0 obj<> endobj 36 0 obj<>stream 87 0 obj 0000075451 00000 n <>/Subtype/Form/Type/XObject>>stream <>stream <>/Subtype/Form/Type/XObject>>stream You can get medical advice, a diagnosis or a prescription by video or phone. endobj 126 0 obj Aetna Open Choice PPO Network. <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 344.836 599.04 449.16 617.818]/Subtype/Widget/T(Identification Number)/TU(Identification Number)/Type/Annot>> 0000220357 00000 n 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. 10 0 obj Comprehensive cost management helps eliminate waste and generates an additional 4 percent savings from billed charges. endobj <>/Subtype/Form/Type/XObject>>stream 0000026631 00000 n You can also click here for our Member User Guide. 0000222118 00000 n endstream Hl <>/Subtype/Form/Type/XObject>>stream All other Plans (California) 888-632-3862. endobj 93 0 obj Click the Register button to get started. All rights reserved. xPpurb & EDI: https://www.health-mental.org/meritain-health-claims-mailing-address/ Category: Health Show Health 49 0 obj endobj xPpurb & 11 0 obj 0000020823 00000 n <>/Subtype/Form/Type/XObject>>stream 158 0 obj <>/Subtype/Form/Type/XObject>>stream HMO Based Plans (California) 800-624-0756. endobj Or fax to (763)-852-5057. <>/Subtype/Form/Type/XObject>>stream <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 166.2 483.36 303 499.68]/Subtype/Widget/T(Spouses Social Security Number)/TU(Spouses Social Security Number)/Type/Annot>> 0000030597 00000 n 98 0 obj 0000030860 00000 n endstream Lastly, just mail the completed form and original invoice to , https://www.employeeconnects.com/wp-content/uploads/2021/06/Grand-Rounds-Submitting-a-Claim.pdf, Health (9 days ago) WebHealth Claim Form - KP Health (Just Now) WebHealth Claim Form Complete and send to: Meritain Health P.O.
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