Download Claim Form and fill out it.
The claims materials that need to be submitted are as follows：
1) Completed Claim form
2) Your Insurance ID Card
3) Original itemized invoices with fees on Physician/Hospital letterhead.
Invoice must include patient’s full name, date of birth, Diagnosis (type of Illness), date of the visit, Treatment type, Physician’s charges
4) The acceptable proof of payment (credit card receipt)
Send Claims Materials by any following ways:
PayerFusion Holdings, LLC
* Claims must be received by the claims department within 120 days of the date of Service to be eligible for reimbursement of covered expense.
United States: +1-855-773-7810
International: +1-786-453-4008 (collect)
If your plan names are Atlas America(ATA)/Student Secure(SS)/Patriot Exchange Program(PEP),above information is not suitable for use, please contact us for detailed claims guide.