Univ. IRS Form 1095-B © 2020 United HealthCare Services, Inc. 2020 United HealthCare Services, Inc. Box 809025, Dallas, Texas 75380-9025 Customer Service: 1-800-767-0700 NOTICE REGARDING TRANSLATOR AND INTERPRETATION SERVICES We provide, upon request, interpreter and translation services related to administrative procedures and claims processing. Department 469.229.5625. The Enrolling Group must also maintain a minimum contribution requirement of the P Download and print your insurance card at UHCSR.com. dallas, tx 75380. Remember to bring your insurance ID card for your appointment. INTERGROUP SVCS P.O. Providers in network with CareFirst should mail claims direct to Carefirst for pricing. Paid by card – Please provide a bank statement that includes your personal information and the care provider information. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. Please download, complete, and submit the form with original pharmacy receipt(s). Our representatives will help you with any issues related with using your health insurance, doctor visits, downloading insurance IDs, and filing claims. Once the Claim Department receives the documentation, your appeal will be reviewed and a written response will be mailed to you. Required fields are marked *. Plan Administration UnitedHealthcare StudentResources 2301 West Plano Parkway, Suite 300 Plano, TX 75075 UnitedHealthcare StudentResources PO Box 809025 Dallas, TX 75380-9025 1-866-948-8472 Email: GKClaims@uhcsr.com PO Box 809025 Dallas, TX 75380-9025. The Enrolling Group must maintain a minimum participation requirement based on the Group Policy. P.o. Or fax it to: 469-229-5625. Box 809025 Dallas, TX 75380-9025 It explains what amount of your medical bill was paid by the insurance company and what amount is your responsibility. Box 809025 Dallas, TX 75380-9025 1-866-648-8472 Important Phone Numbers *For a life-threatening emergency call 911, or if on campus, call campus safety at (303)-871-3000. AXIS PROFESSIONAL LABS LLC can be reached at his practice location using the following numbers: Phone: 469-995-7792 Fax: 469-995-8238 The provider's official mailing address is: PO BOX 803525 DALLAS, TX 75380-3525, US The contact numbers associated with the mailing address are: If you are a student and would like to check on the status of a claim that you or a provider submitted, you will need to set up a My Account if you have not done so already. Below is detail information. Please note that the EOB is not a bill. Mail to: United Healthcare Student Resources PO Box 809025 Dallas, TX 75380-9025 Fax to: 469-229-5625 Email to: [email protected] Prescriptions PO Box 809025. PO Box 809025 Dallas, TX 75380-9025. PHONE. SHIP is here to make your insurance purchase as quick and easy as possible Contact Us We're happy to answer questions or help with the following: General Benefits Enrollment My Account Life Status Changes Please fill out the form on this page and we will contact you with All Optum Rx participating pharmacies can file “electronically” and be reimbursed at the point of purchase. CLAIMANT INFORMATION . Submit claim to UnitedHealthcare StudentResources PO Box 809025 Dallas, TX 75380 … Box 809025, Dallas, TX 753809025 - (This is listed on your ID card) Fax claim to: 469-229-5625 or You do not need to submit a claim if you visit an in-network hospital or doctor. An evidence that shows you have already paid for the service. Phone Number ... P. O. Customer Service agents are available Monday through Friday, 7:00 AM to 7:00 PM Central Standard Time (5:00 AM to 5:00 PM Pacific Standard Time). You can also correspond with Dr. Solomon Mollik Azouz through mail at his mailing address at Po Box 801209, , Dallas, Texas - 75380-1209 (mailing address contact number - --). ... P.O. Please submit the three documents to UHCSR through one of the following ways: UnitedHealthcare Student Resources You do not need an additional claims form. 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. This form is used for reimbursement of prescription drugs. Make sure your name, health insurance ID number, and school name are on the bill. Pharmacy Claim Form. You can also correspond with Robert L Rinkenberger through mail at his mailing address at Po Box 802943, , Dallas, Texas - 75380-2943 (mailing address contact number - 214-630-1080). For Terms and Conditions, click here. Please visit our My Account Center to log in to an existing account or to create a new one. Location Health & Counseling Center Daniel L. Ritchie Sports & Wellness Center, 3rd floor North 2240 East Buchtel Boulevard Denver, CO 80208-3230 Plans supported include UnitedHealthcare Dual Complete® , Children's Health Insurance Program (CHIP), STAR, STAR+PLUS, UnitedHealthcare Connected® , and STAR Kids. Claim Form only needed if provider does not submit claim. PO Box 809025 Dallas, TX 75380-9025. WellMed Claims address PO Box 400066 San Antonio, TX 78229: 78857 Medical care institutions will contact and send your claim to UnitedHealthcare directly. Your Explanation of Benefits can be viewed on UHCSR MyAcccount. of Colorado – Anschutz Medical Campus 2019-202512-1 Massage Therapy Reimbursement Form Instructions: Please complete form and submit with proof of payment for services rendered within 90 days of the Date of Service. Box 809025 Dallas, TX 75380-9025. Claimant’s Name Date of Birth . Phone Number . There are 29 company that have an address matching Po Box 801827 Dallas, TX 75380. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. Box 809049 Dallas, TX 75380-9049 . The response will include what the findings were if the appeal was approved or denied, and the reason for the final decision. PO Box 809025 Dallas, TX 75380-9025 Electronic Payer ID #: 74227 NOTICE TO ALL HEALTHCARE PROVIDERS This card is not a guarantee of coverage. Or fax to: 469-229-5625 . I hereby authorize any physician, hospital, or other medical provider to release any information regarding the medical history, ... P. O. The University of Idaho toll free phone number is 1-800-767-0700. Or the student can pay for the prescription and file for reimbursement using an Optum Rx Reimbursement Claim Form. Street Name (Include Street Number or PO Box) City State Zip . Box 660270 Dallas, Texas 75266-0270 . Dallas, TX 75380-9025. His current practice location address is 7777 Forest Ln Ste C802, , Dallas, Texas and he can be reached out via phone at 972-702-8888 and via fax at --. Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475, 800-800-7616. Pharmacy Claim Form. P.O. The RX Bin #), PCN # and Group #  along with the student’s individual 7-digit ID number will need to be entered. His current practice location address is 7777 Forest Ln Ste C655, , Dallas, Texas and he can be reached out via phone at 972-566-5212 and via fax at 972-566-2372. Or fax to: 469-229-5625 . Phone___(800) 767-0700_____(required) Fax___(800) 506-9278_____(REQUIRED IF INFO IS TO BE FAXED OR A FEE WILL BE CHARGED) _____ NOTE: Please check the box for ONE of the following options and describe the required information to be released SEND THE FOLLOWING I hereby authorize the Student Health Center to release X FAX (469) 417-1969. PO Box 809025 . Note: When sending claim information: Clip, do not All of this information is located on the student’s ID card. staple, all bills to the completed form. Pharmacy Claim Form. For information concerning coverage, co-payment and claims instructions, please call Customer Service at the number listed on the front of this card. Box 981806 EL PASO, TX 79998-1806 WWW.IGS-PPO.COM 1-800-537-9389. Customer Service: 1-800-767-0700 MAIL. Note: We recommend that you add a brief description explaining your claim or situation to facilitate the process. 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. 75380-9099 is a ZIP Code 5 Plus 4 number of 809099 PO BOX , DALLAS, TX, USA. PHONE. Hard Copy Submission – Provider or Student may mail to: If the student does not have his/her ID card when filling a prescription, an Optum Rx pharmacy has up to 30 days to electronically file the claim. 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