In order to process the claim, the claim's administrator will need the following:
- Claim Form for appropriate insurance you are filing for - filled out by you
- EOB (Explanation of Benefits) statement from insurance company
- Get this from your provider - NUCC Claim Form from Provider (OMB-0938-1197) 1500
- Itemized bills or anything else that the claims administrator might request
- If you paid the provider for service already, send proof of payment.
See attached form for an example of the NUCC Claim Form that you request from your Provider to send in with your claim form.
Do you have questions about what you need to send in, you can either contact the Claim's Administrator for the insurance you are filing the claim form (you can locate the phone number on the back of your ID card that correlates to the type of insurance you are filing the claim) or you can contact us at 866.438.4274 and we can help you find out what you need.
Important: Healthy America and United Business Association (UBA) are not authorized to pay claims or be involved in the claims decision process. All claim decisions are made by the TPA claims administrator and the insurance carrier.