Before submitting your need, ensure your detailed, itemized medical bill includes all the following required information:
- Name of Member/Patient
- Charged Amount
- Date of Service (DOS)
- Diagnosis code(s) (ICD-10)
- Procedure code(s) (CPT)
- Provider Name
- Provider’s Tax ID Number (TIN)
- Provider’s billing address
- Provider’s physical address
- Receipt - (if already paid)
- Explanation of Benefits (EOB) - (if you have primary insurance/Medicare)
You can submit the need within your Member Care Portal. If your medical need requires Pre-Notification, ensure that the Care Coordination Team has reviewed it before submitting your need.