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)
Submit claim materials online:
Login to DIANins member account My Account
Upload claim materials through My Account - Claim Info - Submit Claim
(After the uploading, you may click View Claim to check the application record and confirm the claim status)
Tips：
* Claims must be received by the claims department within 180 days of the date of Service to be eligible for reimbursement of covered expense.
* Users who apply for a claim for the first time will receive an invitation email from PayerFusion to register a Tipalti collection account, please pay attention to check this email. If you cannot receive this email due to email problems, please contact corpclaims@payerfusion.com or 1-855-773-7810 to resend the email.
United States: +1-855-773-7810
International: +1-786-453-4008 (collect)
E-mail: Conciergecare@payerfusion.com
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.