2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 71
CLAIM AND APPEAL PROCEDURES
You will receive an Employee identification card which will contain important information, including claim filing
directions and contact information. The Employee identification card will show your Participating Provider Network
and the Medical Management Administrator.
At the time you receive treatment, show the Employee identification card to your provider of service. In most cases,
your provider will file your claim for you. You may file the claim yourself by sending it to the address listed on the
Employee identification card. Other general information or inquiries should be sent to:
Meritain Health, Inc.
P.O. Box 27810
Minneapolis, MN 55427-0810
(800) 925-2272
Most claims under the Plan will be “post service claims.” A “post service claim” is a claim for a benefit under the Plan
after the services have been rendered. Post service claims must include the following information in order to be
considered filed with the Plan:
(1)
The date of service;
(2)
The name, address, telephone number and tax identification number of the provider of the services or
supplies;
(3)
The place where the services were rendered;
(4)
The diagnosis and procedure codes;
(5)
The amount of charges (including Network repricing information);
(6)
The name of the Plan;
(7)
The name of the covered Employee; and
(8)
The name of the patient.
A call from a provider who wants to know if an individual is covered under the Plan or if a certain procedure or treatment
is a Covered Expense before the treatment is rendered, is not a “claim” since an actual written claim for benefits is
not being filed with the Plan. Likewise, presentation of a prescription to a pharmacy does not constitute a claim.
Timely Filing
All claims must be filed with the Claims Administrator within 1 year following the date services were Incurred. Claims
filed after this time period will be denied.
For Medical, Dental and Vision Claims
Meritain Health
P.O. Box 853921
Richardson TX 75085-3921
800-925-2272
For Prescription Drug Claims
OptumRx
P.O. Box 9472
Minneapolis, MN 55440-9472
(855) 896-9779
www.optumrx.com
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