How to File a Claim
In most cases, providers and facilities file claims for you.
You must file a claim when:
- You receive services outside the United States.
- Another group health plan is primary.
- You use an Out-of-Network provider.
Submit Services on the Member Medical claim form and include an itemized bill that includes the information below:
- Primary member name
- Patient name
- Date of Service (mm/dd/yyyy)
- Type of service/Procedure code
- Charge for the service
- Health care professional name/credentials
- Health care professional address
- Health care professional Tax ID number
- Diagnosis code (ICD format)
Where to File
All medical claims (except when Medicare is the primary payer) should be submitted to:
Cigna HealthCare
P.O. Box 188004
Chattanooga, TN 37422-8004
Mental Health and Substance Abuse Claims
OptumHealth Behavioral Solutions provides our mental health and substance abuse (MHSA) benefits. To be eligible to receive enhanced MHSA benefits, treatment must be preauthorized by calling 1-866-512-3767.
Claims should be submitted to:
OptumHealth Behavioral Solutions
P O Box 30755
Salt Lake City UT 84130-0755
When Medicare is the primary payer, and will not cover your services, call the Plan at 703-729-4677 or 1-888-636-NALC (6252) to obtain benefits. Claims for Medicare-primary patients should be submitted to:
NALC Health Benefit Plan for Employees and Staff
P O Box 678
Ashburn, Virginia 20146
Note: You do not need to preauthorize treatment when Medicare covers your services.
When Medicare is Primary
When Original Medicare is the primary payer, Medicare processes your claim first. Your copy of the Medicare Summary Notice (MSN) will include a statement confirming that a secondary claim has been filed with the Plan. If Medicare is primary, and your MSN does not show this message, submit a paper claim, including the MSN, to:
NALC Health Benefit Plan for Employees and Staff
P O Box 678
Ashburn, Virginia 20146
CVS/Caremark
If you purchase prescriptions at a non-network pharmacy, foreign/overseas pharmacy, or elect to purchase additional refills at a preferred network pharmacy, other than at a CVS/Caremark Pharmacy, or at an NALC CareSelect Network pharmacy, complete the short-term prescription claim form. Mail it with your prescription receipts to the NALC Prescription Drug Program. Receipts must include the patient's name, prescription number, name of drug, prescribing doctor's name, date, charge, and name of pharmacy.
When you have other prescription drug coverage, and the other carrier is primary, use that carrier's drug benefit first. After the primary carrier has processed the claim, complete the short-term prescription claim form, attach the drug receipts and other carrier's payment explanation and mail to the NALC Prescription Drug Program.
NALC Prescription Benefit Program
P O Box 52192
Phoenix, Arizona 85072-2192
Note: If you have questions about the Program, wish to locate a preferred network pharmacy, NALC CareSelect Network retail pharmacy, or need additional claim forms, call 1-800-933-NALC (6252) 24 hours a day, 7 days a week
QUESTIONS?
Call the Plan at 703-729-4677 or 1-888-636-NALC (6252) if you need assistance.
