Consumer Driven Health Plan
How to File a Claim
In most cases, providers and facilities file claims for you.
When you must file a claim:
- You receive services outside the United States
- Another group health plan is primary
- You use an Out-of-Network provider
Submit services on the CMS1500 or a claim form that includes the information shown below:
- Patient's name, date of birth, address, phone number and relationship to enrollee;
- Member identification number as shown on your identification card;
- Name, address, and tax identification number of person or facility providing the service or supply;
- Signature of physician or supplier including degrees or credentials of individual providing the service;
- Dates that services or supplies were furnished;
- Diagnosis;
- Type of each service or supply;
- Charge for each service or supply; and
- If another group health plan is primary, send a copy of their explanation of benefits.
Where to File
All medical claims should be submitted to:
NALC Value Option
P.O. Box 188050
Chattanooga TN 37422-8050
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 Value Option
P.O. Box 188050
Chattanooga TN 37422-8050
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 or NDC#, prescribing doctor's name, date of fill, charge, name of pharmacy, metric quantity, and days supply.
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 Drug Program
PO Box 52192
Phoenix, AZ 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 800-933-NALC (6252) 24 hours a day, 7 days a week.
Questions?
Call the Plan at 855-511-1893 if you need assistance.