endobj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 418.2 395.16 579.6 417.36]/Subtype/Widget/T(Name of Policy Holder)/TU(Name of Policy Holder:)/Type/Annot>> x33U0t.=s#0agf$LR If your ID card is available, please use the number on the back for faster service. Shop Insurance. endstream 11 0 obj "LR endobj endstream endobj endobj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 493.92 371.76 507.6 393.96]/Subtype/Widget/T(State_2)/TU(State)/Type/Annot>> Vgmf9q0ATr@ XaFr ` ! 148 0 obj 0000269194 00000 n endobj endobj Call Meritain (866) 209-3061 to obtain claim #; then call IBEW-IL (618) -2002 to get claim status. endstream Access information quickly , https://www.meritain.com/wp-content/uploads/2021/02/Microsoft-Word-Vision-Claim-Form_TX-853921.pdf, Health (1 days ago) WebRepresentatives are available on the general line from 7:00 AM8:00 PM CT. To reach us by email: [emailprotected] Access your information quickly For 24-hour access to , https://www.meritain.com/about-us-self-funded-employee-benefit-plans/meritain-health-member-services/, Health (3 days ago) WebElectronic Claims Address CLAIM STATUS/ PROVIDER RELATIONS APPLICABLE STATE Carpenters Health & Welfare Trust Fund Meritain Health PO Box 853921 , https://www.mbh-eap.com/wp-content/uploads/Claim-Submission-and-Payment-Addresses-2020-r2.pdf, Health (5 days ago) WebThe name, address and telephone number of the provider. endobj 0 endobj 120 0 obj <<3E4E844C759D00498F9F96196CE1CA18>]>> <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 102.24 622.44 341.16 644.52]/Subtype/Widget/T(Name last first initial)/TU(Name \(last, first, initial\))/Type/Annot>> Administered by Meritain , Health (3 days ago) WebYou can call Meritain Health Customer Service: {For verification of eligibility and benefit information. endstream <>/Subtype/Form/Type/XObject>>stream x3P0 t.C=63E\i\ g3s endobj Whether you're building an employee benefits program, researching your member benefits or offering support to your patients, we're ready to help you do more with your health plan. endstream endobj xPpurb & 0 Provider. H23U0t.=s#0agf!R@PBLX n <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 142.44 254.76 219.48 279]/Subtype/Widget/T(Injury Illness Date and time of accident)/TU(Injury Illness Date and time of accident:)/Type/Annot>> endobj The Authorization for Release of Information form is required according to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), specifically 45 CFR 164.508 of the HIPAA Regulations. Meritain Health endobj <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 4 0 R /Rect[ 266.76 352.32 276.84 362.4]/Subtype/Widget/T(Individual)/TU(Individual)/Type/Annot>> Visit our Meritain Health YouTube channelOpens in new window to learn more. <>/Subtype/Form/Type/XObject>>stream xPpurb & endstream endobj endobj <>/Subtype/Form/Type/XObject>>stream Were adding new tools and resources all the time. HWnF}G(W{_04A>ye $wfI@b3mltGgI4xmjwKfIah8`g4Bp0z'}$O2%. endobj 0000078102 00000 n x 56 0 obj <>/Subtype/Form/Type/XObject>>stream 40 0 obj 37 0 obj 36 0 obj 0000243792 00000 n 0000078515 00000 n 0000221985 00000 n endstream endstream <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 359.04 622.44 377.16 644.52]/Subtype/Widget/T(Sex)/TU(Sex)/Type/Annot>> More goes into building one than you might think. endobj <>/Subtype/Form/Type/XObject>>stream endobj xPpurb & 102 0 obj Q(e-26ChrQm~*o5+f9L;?5"+wg3^.N?&18/5Nww8,,%j&`f)%i,cdeGZZ yuU`&ZfwZ1)`YO>E+*w* 123 0 obj Your patients health and your ability to access their information is important to us. endobj H23U0t.=s#0agf!R H23U0t.=s#0ag 0000070325 00000 n Your signature and your understanding of what it means <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 27.84 348.36 201.72 364.68]/Subtype/Widget/T(Other Insurance Carriers or Plans Telephone)/TU(Other Insurance Carriers or Plans Telephone #)/Type/Annot>> endobj Meritain Health Claims Mailing Address Health (9 days ago) WebClaims Information UFCW Local 655 Welfare Fund. 0000003072 00000 n 146 0 obj H23U0t.=s#0agf!R@PBLX n endstream xPpurb & 27 0 obj For 24-hour , https://qa.meritain.com/about-us-self-funded-employee-benefit-plans/meritain-health-provider-services/, Health (8 days ago) WebMailing Address. x endobj /I|;5iqOb: 8]m endobj endobj endstream Do you need a referral to see a specialist? Please forward this completed form to the privacy officer of the employer or to: Meritain Health 0000195598 00000 n For 24-hour automated phone benefits and claims information, call us at 1.800.566.9311. <>/Subtype/Form/Type/XObject>>stream xPpurb & <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 27.84 51.72 251.28 68.64]/Subtype/Widget/T(Providers tax ID number or Social Security Number)/TU(Providers tax ID number or Social Security Number)/Type/Annot>> 69 0 obj 0000030597 00000 n 151 0 obj Address, phone number, and practice changes Contact us online Contact us by phone For non-participating health care professionals Network applications (behavioral health, dental, facility, and pharmacy) Practice changes and provider termination Request a medical application Request Part D pharmacy participation endstream endobj endstream endobj 139 0 obj <> endobj endobj For 24-hour automated phone benefits and claims information, call us at 1.800.566.9311. 0000006809 00000 n 25 0 obj <> endobj 87 0 obj :Y iy}3q:tGp#bI4jH"KAmME#LVAdE!Q(?PS-uxqGkF&oeNwuS%uARm3E|wpy % <>/Subtype/Form/Type/XObject>>stream <>/Subtype/Form/Type/XObject>>stream trailer H23U0t.=s#0agf!R . 104 0 obj Mail the Claims Form and supporting documents to the address on the Claim Form or on the back of your Member ID Card. 121 0 obj xPpurb & endobj endobj Access information quickly For 24-hour access to your patient's health information, log in to your endobj To reach us by phone, dial the toll-free number on the back of the patient . PDF How to Submit a Claim - Larimer County, Colorado endstream endstream xPpurb & endobj <>/Subtype/Form/Type/XObject>>stream <>/Subtype/Form/Type/XObject>>stream xPpurb & ,L"\H4~Zzyv4vet{&+8*BYOl+:;C ks#6i}$9wNB;I@~d hop^F. To reach us by phone, dial the toll-free number on the back of the patients ID card. Comprehensive cost management helps eliminate waste and generates an additional 4 percent savings from billed charges. 78 0 obj 0000263474 00000 n 0000007254 00000 n endstream x endobj endstream <>/Subtype/Form/Type/XObject>>stream H23U0t.=s#0ag endobj <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 4 0 R /Rect[ 237.84 238.2 247.8 248.16]/Subtype/Widget/T(undefined_3)/TU(undefined)/Type/Annot>> 25 16 PDF Claim Submission and Payment Addresses - mbh-eap.com %PDF-1.7 26 0 obj 110 0 obj 10 0 obj To reach us by phone, dial the toll-free number on the back of the patients ID card. endstream 0000016302 00000 n Box 30111 Health (3 days ago) WebAddress: Telephone #: City: State: Zip: Is this a change of address? 0000262626 00000 n endobj endstream Have you checked out your personalized web site? 0000002739 00000 n If you're a Member or Provider please call 888-509-6420. x3P0 t.C=63E\i\ g3s <>/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>>