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 sevices on the HCFA-1500 or a claim form that includes the information shown below:

• Patient's name and relationship to enrollee;
• Member #;
• Name, address, and tax identification number of provider or facility;
• Signature of physician or supplier including degrees or credentials;
• Dates of service;
• Diagnosis (ICD-9 Code);
• Description of service (CPT/HCPCS Code);
• 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 (except when Medicare is the primary payer) should be submitted to:

CIGNA HealthCare
P.O. Box 5909
Scranton, PA 18505

Mental Health and
Substance Abuse Claims

OptumHealthSM Behavioral Solutions (formerly United Behavioral Health) provides our mental health and substance abuse (MHSA) benefits. To be eligible to receive enhanced MHSA benefits, treatment must be preauthorized by calling 1-877-468-1016.

Claims should be submitted to:

OptumHealthSM 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
20547 Waverly Court
Ashburn VA 20149

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
20547 Waverly Court
Ashburn VA 20149

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 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 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.