When & How To Submit
Medical Claims
You have no paperwork when you
visit a participating provider for treatment of a covered
service. Participating physicians automatically submit
their charges to PrimeSource for processing. You have no
payment obligations on the day of your office visit except for a
medical co-pay your plan may require. Claims will be paid
directly to the physician's practice, and you will be notified
by the provider of any balance that you owe.
When you use a
non-participating provider however, you may have to submit a
claim form for each visit to receive reimbursement. Claim
forms can be obtained from the human resources office of your
employer. Send completed claim forms to the address
provided on your I.D. card within 90 days of your office visit
to assure reimbursement.
Also, non-participating
physicians may ask you to pay for the exam and any procedures
performed at the time of your visit. Keep in mind that the
plan will reimburse a lesser amount for the same services
provided by a non-participating physician, increasing your
out-of-pocket expense for care.
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Harrisburg PA 17104-1612