Premium Payments Mailing Address: PO Box 14998, Oklahoma City, OK 73113 Agent Services Phone: (888) 524-3629 Mailing Address: PO Box 14498, Oklahoma City, OK 73113 Claims Phone: (888) 524-3629 Fax: (385) 207-7883 Mailing Address: Medicare Supplement Claims PO Box 211635 Eagan, MN 55121P.O. Box 21146 Eagan, MN 55121. Our Corporate Street Address: In the Central New York and Southern Tier Regions: Excellus BlueCross BlueShield 333 Butternut Drive Syracuse, NY 13214-1803. In the Rochester Region and Nationwide: Excellus BlueCross BlueShield 165 Court Street Rochester, New York 14647. In the Utica Region: Excellus BlueCross ...EMI Health, PO Box 21482, Eagan, MN 55121. Can I send my COB (coordination of benefits) claims electronically? Yes, EMI Health accepts COB Claims through EDI. ... (Replacement of Prior Claim) in the Code box and the original claim number in the Original Ref No. box. In box 19 - Claim Notes, enter CORRECTED CLAIM. If you are voiding a CMS 1500 ...• Mail medical paper claims to: AMIDA CARE Claims, P.O. Box 21455, Eagan, MN, 55121 • Electronic submitters use Amida Care submitter ID #79966 • To check the status of a claim, or to check eligibility call Provider Services at 1-800-556-0674 • Mail Behavioral Health paper claims to: Beacon Health Strategies, Amida Care Health Plan Claimsbox, complete the free form areas, select a role, select General Dentistry in the Practice ... PO Box 21146 ; Eagan, MN 55121 ; Coordination of Benefits (COB) [email protected] DenteMax is a national Preferred ... PO boxes are not acceptable. Electronically [email protected] Fax 1-800-676-6285PO Box 21099 Eagan, MN 55121 Recoupment for After 1/1/2021 Dates of Service • Check for the applicable amount paid to: Maryland Physicians Care • Original Explanation of Payment ... PO Box 1104 Portland, ME 04104 Fax: 833-656-0648 Appeals sent to any other address will be returnedP.O. Box 211471 Eagan, MN 55121 The EDI payer ID has changed to: Unite Here Health (dba Culinary Health Fund) Payer ID: 59144 Claims submitted to the prior P.O. box and Payer ID will be forwarded to the correct location for the time being. If you have any questions, please contact provider services at (702) 892-7313, option 2. Sincerely,Eagan, MN 55121-2892 CountyCare P.O. Box 3727 . Corpus Christi, TX 78463; Grievances, Medical Appeals, and non-claim correspondence . County Care Health Plan P.O. Box 21153 ... Chicago, IL 60680 . CountyCare . ATTN: Claims Appeals . PO Box 804417 . Chicago, IL 60680 . CountyCare has set up mail forwarding with the USPS through October 2018 to ...Billing Address: P.O. Box 21036 Eagan, MN 55121 Plan Products: Commercial Self-Funded, TriWest CCN Co-payments: Refer to Member ID Card Benefit Questions: Refer to Member ID Card Referral / Precertification: Refer to Member ID Card Timely Filing: 120 Days from Date of Service Timely Payment: 30 Days from Receipt of …P.O. Box 21552 Eagan, MN 55121 How to Read your Explanation of Benefits Statement: 1. Date of Service - The date(s) service was provided. ... PO Box 91102, Seattle, WA 98111, Toll free: 855-332-6396, Fax: 425-918-5592, TTY: 711, Email [email protected]. You can file a grievance in person or by mail, fax, or email. If ...P.O. Box 21341 Eagan, MN 55121. WPS Administrative Services WPS Health Plan P.O. Box 21352 Eagan, MN 55121. Additional Contact Information. Correspondence (medical records, notes, etc.) Wisconsin Physicians Insurance P.O. Box 8190 Madison, WI 53708-8190. EDI (Electronic Data Interchange)P. O. Box 21660 Eagan, Minnesota 55121-0660 Fax: 1-402-496-8199 34 113 0982 0915 US Note: Your Policy has a 6 Month Pre-Existing Conditions Limitation and a 2 Year Policy Contestability Period. A claim happening during the first two years may require additional information. If wePO Box 21631 : Eagan, MN 55121 . OR . Electronic claims are to be submitted to: PEAK TPA Payer ID 27034 . D. Invoices for services rendered to Central Valley PACE: Invoices for services rendered to PACE participants must be submitted to Central Valley PACE within 90 calendar days. Institutional providers should use Form UB92 (HCFAProvider Relations Directory. Dominion National : 888.471.3631. Dominion USA, Inc. (formerly DentaQuest Mid-Atlantic and Virginia): 888.471.3631. Providence Health Plan: 855.612.7478. Premera Blue Cross: 855.612.7477. Get in touch with a customer service representative fast. Contact Dominion National through our secure online form.Better Living Now - Health Care Products, Programs and Services. Entrust Address: Attn Claims PO Box 211348 Eagan, MN 55121-0000. Website: https://entrustpayroll.com Telephone: 844-632-7878.PO Box 1605. Colleyville, TX 76034 ... Eagan, MN 55121 (888) 547-5080 Medical Providers Call. 988 Suicide & Crisis Lifeline. Hours: Available 24 hours. Languages: English, Spanish. Learn More. 988 Dial 988 from any phone to be immediately connected. Home Benefits Enroll ...PO Box 21917 PO Box 21327 Eagan, MN 55121 Eagan, MN 55121 1-800-338-6833 (TTY 711) 1-800-338-6833 (TTY 711) You can file a grievance in person, by mail and by phone. If you need help filing a grievance, call 1-800-338-6833 (TTY 711). You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office ...PO Box 211342 Eagan, MN 55121-1342 Prior Authorization: Visit the provider portal Fax: 800-626-3042 Phone: 866-384-3488 Provider Service: swhpprovider.firstcare.com Phone: 844-633-5325 Possession of this card or obtaining precertification does not guarantee coverage or payment for the service orPO Box 211256 Eagan, MN 55121- 2656 UniveraHealthcare.com . Dental Claims Processing Made Easier. We have some exciting updates coming to our dental claims processing system for groups currently covered under the dental plan. The new system will improve the overall member experei nce in the following ways:Excellus Blue Cross Blue Shield Address: PO Box 21146 Eagan, MN 55121-0000 Website: https://WWW.EXCELLUSBCBS.COM Telephone: 800-920-8889 ; Mail Order Disposable Medical Supplies Are you very busy? Why wait in lines at pharmacies and medical supply stores? ...Mail disputes to: Provider Disputes, PO Box 211624, Eagan MN 55121. For electronic instructions and submission, visit Sutter Link. ... PO Box 14165 Lexington, KY 40512-4165 (800) 949-2961 (Fax) Stanford Health Care Advantage Claims Attn: Non-Contracted Provider Appeals P.O. Box 71210Check claims, benefits, or eligibility. Ask questions about your bill or make payment. Ask questions about your pharmacy benefits. 1-800-662-5851. 1-801-262-7475. [email protected]. 6:00 am to 6:00 pm MT Monday-Friday Emails and texts are monitored during business hours only. Access benefits, claims, and eligibility information 24/7 online with ...Harvard Pilgrim Health Care, Inc. c/o Stride Claims Processing. P.O. Box 211067. Eagan, MN 55121. This address has replaced all previous addresses in Lubbock, TX (P.O. Boxes 16755, 93430, and 6748). Any correspondence sent to these addresses for Harvard Pilgrim Stride SM (HMO)/ (HMO-POS) Medicare Advantage will be forwarded to the new PO Box ...PO Box 21146 Eagan, MN 55121- 0146 ExcellusBCBS.com . Dental Claims Processing Made Easier. We have some exciting updates coming to our dental claims processing system for groups currently covered under the dental plan. The new system will improve the overall member experei nce in the following ways:P.O. Box 211256 Eagan, MN 55121 . Mail Forms and Payments. Direct Premium Payments. Univera Healthcare P.O. Box 5267 Binghamton, NY 13902-5267. Claims & Membership Forms.Saint Paul, MN 55121 - Peer Comparisons by Rank and Percentile. The table below compares 55121 to the other 878 ZIP Codes in Minnesota by rank and percentile using July 1, 2023 data. The location Ranked # 1 has the highest value. A location that ranks higher than 75% of its peers would be in the 75th percentile of the peer group.Claims Submissions. Two ways to submit claims: EDI-SA001; Mail: Signature Advantage, PO Box 21063 Eagan, MN 55121Fax: 1-855-969-5876 Email: [email protected] Mailing Address: PO Box 21063, Eagan, MN 55121 Compliance Hotline. Phone: 1-833-352-7924 Email: [email protected] Mailing Address: PO Box 21063, Eagan, MN 55121 Compliance OfficerP.O. Box 211256 Eagan, MN 55121 OR Excellus Health Plan, Inc. EDI Solutions P.O. Box 21146 Eagan, MN 55121. It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter. Waiting for a ResponseP.O. Box 211308 Eagan, MN 55121-2908 . To mail premium payments, address to: Fallon Health P.O. Box 847231 Boston, MA 02284-7231 Or, pay online. Corporate office Fallon Health 10 Chestnut St. Worcester, MA 01608 1-508-799-2100 1-800-333-2535 Monday through Friday, 8 a.m. to 5 p.m. Public Relations/Media inquiries Melissa Randall …PO Box 21146 Eagan, MN 55121-0146 ExcellusBCBS.com . FORM - MXCNY. MEDICARE ELIGIBILITY FORM . Group Number: Group Name: Subscriber ID Number: Member Name: CHECK ONE STATEMENT THAT REPRESENTS YOUR TOTAL EMPLOYEE POPULATION: _____Employs 20 or less _____Employs 20 or morePO Box 21051 Eagan, MN 55121-0051 Medica Behavioral Health Claims: PO Box 30757, Salt Lake City, UT 84130 Payer ID: 87726 Medica Behavioral Health Services: (800) 848-8327 Medica Customer Service: (877) 329-8310 TTY Users: 711 Pharmacists: (800) 922-1557 Providers: (800) 458-5512 or medica.com Health Advocate NurseLine: (866) 668-6548Service: 877-874-6385 Sales: 212-300-0739 Fax: 212-214-0892PO Box 211008, Eagan, MN 55121 Fair Processing Notice The GBG Group includes insurance companies, brokering and management companies, as well as assistance and operations companies. We respect your privacy and we are all committed to protecting your personal information.P.O. Box 21146 Eagan, MN 55121-0146 Attn: Form 1095-B Request. Call Us. If your employer provides your health insurance and the Form 1095-B is not listed in your online …PO Box 21146 Eagan, MN 55121. Y0028_5041a_C. o Laundry services o Meals are not included o Mileage within the transplant city o Other personal items o Postage o Security deposits o Telephone bills and cell phone charges o Toiletries o Toys o Transportation that exceeds coach rates o ...PO Box 21133 Eagan, MN 55121 Provider Lookup: 1-866-511-4757 ... PO Box 1527 Minneapolis, MN 55440 Customer Service: 1-800-997-1750 www.preferredone.com. Delta Dental.Excellus BlueCross BlueShield PO Box 21146 Eagan, MN 55121 . Updated 04/02/2024 . Author: Patricia Laskowski Created Date: 4/2/2024 4:13:46 PM ...PO Box 211286 Eagan; MN 55121 (847) 298-6000 (847) 298-5802; [email protected] 475 1033149844; 475 1033149844; Northwestern Med Phys Network West and NW Suburbs Claims Inquiry; Client Services 1639 N Alpine Rd; Suite 401 Rockford; IL 61107 (888) 322-1608 800-747-2264; [email protected];Paper Claims. Paper claims should be mailed to: Florida Complete Care Attn: Claims. PO Box 21688. Eagan, MN 55121. Instructions for completing the CMS-1500 and UB-04 claim forms can be obtained from the following websites: Centers for Medicare & Medicaid Services www.cms.gov. Florida Hospital Association www.fha.org.Thank you for your message. It has been sent. If you need immediate attention, please call: (855) 887-0855Med Claims: P.O. Box 211375, Eagan, MN 55121 Rx Claims: OptumRx P.O. Box 650287, Dallas, TX 75265-0287 For Pharmacists: 1-877-889-6510 Behavioral Health: 1-844-978-8100 front front back back Sample member ID cards for illustration only; actual information varies depending on payer, plan and other requirements. 2024 UnitedHealthcare UCardPO BOX 211651 EAGAN, MN 55121-6051 Business Entity Printable License * indicates a required field. Business Entity's Last 4 EIN: * License Number: * Change * Uppercase Only. License Information. License # License (Lines of Authority) Status Reason Originally Issued ...To submit this form by mail, return to PO Box 21146, Eagan, MN 55121 Claim adjustments, if completed, will be reflected on your next remittance and online at Provider.ExcellusBCBS.com. A nonprofit independent licensee of the BlueCross BlueShield Association Rev. August 2021PO Box 21702 Eagan, MN 55121 . Email through your Secure Inbox: Simply sign in to your account at premera.com and select . Contact Us > Send Email. Scan and send this completed form and any required documents back to us as a secure email attachment. Questions? Call: 800-607-0546 (TTY: 711) Monday through Friday 8 a.m. to 6 p.m. Pacific TimeEmpower Healthcare Solutions, LLC (Empower) is a Provider-led Arkansas Shared Savings Entity (PASSE). This model of care was developed to address the overall health care needs of Medicaid beneficiaries who have complex behavioral health or intellectual and developmental disability (IDD) service needs. Provider Alerts.PO Box 21455 Eagan, MN 55121 Electronic Submissions: Use Amida Care Submitter ID # 79966. How do I check the status of a claim? Call Provider Services at 1-800-556-0674. How can I appeal a claim denial? You have 60 days from the date of a claim denial to submit an appeal.Saint Paul, MN 55121 - Peer Comparisons by Rank and Percentile. The table below compares 55121 to the other 878 ZIP Codes in Minnesota by rank and percentile using July 1, 2023 data. The location Ranked # 1 has the highest value. A location that ranks higher than 75% of its peers would be in the 75th percentile of the peer group.PO Box 211435 Eagan, MN 55121 Electronic pay ID: 71890. Medica Behavioral Health claims should be submitted to: Medica PO Box 30757 Salt Lake City, UT 84130 Electronic pay ID: 87726. Medica Chiropractic claims should be submitted to: Medica PO Box 212 Minneapolis, MN 55440-0212 Electronic pay ID: 41161o Mail: Send paper claims to SOMOS IPA, LLC, P.O. Box 21432, Eagan, MN 55121 • Emblem: o Electronically: Use SOMOS Payer ID 81336 through Change Healthcare or another approved EDI vendor o Mail: Send paper claims to SOMOS IPA, LLC, P.O. Box 211473, Eagan, MN 55121SimplyBlue Copay & Copay/Deductible. A nonprofit independent licensee of the BlueCross BlueShield Association GROUP ENROLLMENT FORM. P.O. Box 21146, Eagan, MN 55121. Instructions on last page. All Dates = mm/dd/yy PLEASE PRINT CLEARLY. 1 –. Group Employer Information. This section should be completed by the Group Benefits …P.O. 211473. Eagan, MN 55121, 844-990-0255. Company, Network, Type of Claim, EDI or Payor ID, Clearing House, Paper Claim Submission Address, Contact for ...3145 Lexington Ave S, Eagan MN 55121. About. Address: 3145 Lexington Ave S, Eagan MN 55121 Large Map & Directions ; Phone: 651-405-3068; Fax: 651-454-9478; TTY: 877-889-2457; ... PO Box Online; Lot Parking; Eagan Post Office Map. Reviews & Feedback. Have you visited this branch before? Let others know what you think.Aither Health is a healthcare solutions company offering a full suite of innovative products and services for third-party administrators and risk bearing entities such as self-funded employers, health plans and providers.PO BOX 21063 Eagan, MN 55121 Electronic Claims Submission Information State EDI Payer ID Colorado LCO01 Florida LFL01 Illinois LIL01 Michigan LMI01 New Jersey LNJ01 New York LNY01 North Carolina LNC01 . Important Numbers State Call Center (Previously known as Member & Provider Services) ...P.O. Box 211713 . Eagan, MN 55121 . PA Medicare (medical and behavioral health claims): Claims Administrator . P.O. Box 211164 . Eagan, MN 55121 . Paper claims submitted to the old address will be forwarded until July 16, 2023. Paper claims submitted after that date will not be forwarded and can result in denials for timely filing.You may submit claims to Surest (365-day timely filing) electronically at Surest payer ID 25463 or by mail to: PO Box 211758, Eagan, MN 55121 After a claim has been submitted, quickly check claims status on UHCprovider.com or call 844-368-6661 to speak with a specially trained Surest Provider Services representative.916-677-2500. Mailing Address: PO Box 211012. Eagan, MN 55121. The County of Sonoma's Workers' Compensation program compensates employees for disability leave and medical treatment as a result of a work-related injury or illness. Workers’ Compensation benefit regulations are established by the State of California’s Division of Workers ...PO Box 21146 Eagan, MN 55121. Y0028_5041a_C. o Laundry services o Meals are not included o Mileage within the transplant city o Other personal items o Postage o Security deposits o Telephone bills and cell phone charges o Toiletries o Toys o Transportation that exceeds coach rates o ...Florida Health Administrators. P.O. Box 21426. Eagan, MN 55121. Phone: (866) 236-2673. Fax: (954) 901-2711. Did you find what you were looking for? If not, email us at [email protected]. We welcome your feedback. Learn more about TAF's resources for providers.Providers must submit the applicable, completed and legible forms to: ElderServe Health, Inc. d/b/a RiverSpring Health Plans. PO Box 211465. Eagan, MN 55121. Providers may also submit and track paper claims through Smart Data Stream at no cost. To use this option, providers must register on the site with the following link:P.O. Box 211395 Eagan, MN 55121. Reminder: All claims should be submitted electronically, unless required documentation is needed to process claim. Find our EDI vendor information through one of the following: 1. Office Ally Payer ID: HPSJ1 866-575-4120. 2. Change Healthcare (EMDEON) Payer ID: 68035 877-469-3263PO Box 211757 Eagan, MN 55121 Claims & Forms. Medical Claim. For submitting medical claims. Prescriptions Claim. For reimbursement of covered prescription drug claims. PT Mini-Claim Form. For Part-timers to submit with EOB or visit summary. Vision Claim. For reimbursement of covered vision care claims. ...PO Box 21762 Eagan, MN 55121. If you accidently mail to the Premera commercial PO Box, Premera will forward the claim to Evolent. There’s an option to submit HCFA (CMS 1500) claims on the new Individual secure website, however this function isn't available yet.P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is required. Electronic (837P) Loop 2010AA NM108 = XX NM109 = NPI # Paper (CMS-1500) NPI # – Box 33A Q1P AmeriHealth NJ – POS, POS NG Q3A AmeriHealth PA – ERISA POS Q3B AmeriHealth PA – ERISA HMO Q3C AmeriHealth PA – HMO and Self-Funded HMO Q3P AmeriHealth …• PO Box 211322 • Eagan, MN 55121 . Provider Claims Disputes . Providers may request reconsideration of how a claim processed, paid, or denied. These requests are referred to as disputes. FCC has a defined Provider Dispute Resolution process for use by providers who are dissatisfied with how a claim processed, paid, or denied.Apr 1, 2019 ... Eagan, MN 55121-2908. USA. Family Health ... 14670 21146 NETWORK PLACE CHICAGO, IL 60673-1211 ... 11537 PO BOX 860524 MINNEAPOLIS, MN 55486-0524.To submit this form by mail, return to PO Box 21146, Eagan, MN 55121 Claim adjustments, if completed, will be reflected on your next remittance and online at Provider.ExcellusBCBS.com. A nonprofit independent licensee of the BlueCross BlueShield Association Rev. August 2021How Do I Submit a Claim For Reimbursement? - Lucent Health. Let's Talk. Previous Next. Complete a Health Claim Reimbursement Form. Submit the completed form with a copy of a superbill from your provider and a receipt of your payment to: email: [email protected]. or. fax: 615-255-6654, attn: mailroom.P.O. Box 211308 Eagan, MN 55121-2908 . To mail premium payments, address to: Fallon Health P.O. Box 847231 Boston, MA 02284-7231 Or, pay online. Corporate office Fallon Health 10 Chestnut St. Worcester, MA 01608 1-508-799-2100 1-800-333-2535 Monday through Friday, 8 a.m. to 5 p.m. Public Relations/Media inquiries Melissa Randall …PO Box 21948 Eagan, MN 55121. Fax: 877-903-6972. More information. You may experience a change in your tax amount for multiple reasons. Assessment changes, lost exemptions, or property exemption changes; Changes in value (new construction or property improvements) Neighborhood improvements (streetlights, sidewalk repairs, sewer lines)Mail the completed application to: Excellus BlueCross BlueShield, PO Box 21146, Eagan, MN 55121. Copies of applications and applications that are outdated will no longer be accepted. Annual open enrollment and renewal activity should be received no later than 30 days prior to the effective date requested to reduce the risk that members will not ...PO Box 211342 Eagan, MN 55121 Customer Service: 800-321-7947 Prior Authorization: Visit the provider portal Fax: 800-626-3042 Phone: 866-384-3488 Provider Portal: Card Issue Date: 08/01/2020 FOR MEMBERS not guarantee coverage or payment for the service or procedure reviewed.If you can not find what you are looking for or have additional questions, please call (610) 933-0800 for immediate assistance. Contact A-G via mail, phone, fax and email: A-G Administrators LLC. Attn: Springfield Claims. P.O. Box 21013, Eagan, MN 55121. Ph: (610) 933-0800 | Fx: (610) 933-4122. [email protected]. Box 211681 Eagan, MN 55121 For pharmacy support: Contact MedImpact Provider phone line: 844‐401‐2055 Fax: 858‐790‐7100 If you require additional communication or to send form and documents, you may: • Fax to Centivo Support: 716‐219‐1946PO Box 21593 Eagan, MN 55121 Timely Filing NHC Advantage requires providers submit all claims within twelve months from the date of service. Claim Format Standards Standard CMS required data elements must be present for a claim to be considered a clean claim and can be found in the CMS Claims Processing Manuals.PO Box 1219 Newark, NJ 07101-1219 Provider Lookup: 1-800-810-2583 www.bcbs.com. Magnacare. 1600 Stewart Ave, Ste. 700 Westbury, NY 11590 Member Service: 1-800-352-6465 www.magncare.com. Preferred One. PO Box 1527 Minneapolis, MN 55440 Customer Service: 1-800-997-1750 www.preferredone.com. Delta Dental. 1639 Route 10 Parsippany, NJ 07054 ...Welcome to JHS Community, where you will discover the advantages of a Health Care Sharing Ministry. JHS Community consists of individuals and families inspiring grace and compassion as we work hard to serve one another with our friendly team and our cost-effective programs. Here at JHS Community, we work to provide reliable, caring alternatives to traditional health insurance. We offer several ...If you would like GEHA to reconsider our initial decision on your benefit claim, please complete this appeal form. You must write to us within 6 months of the date of our decision. You can mail, fax or email your request to GEHA: Mail your request to Appeals Department, GEHA, P.O. Box 21542, Eagan, MN 55121; Fax your request to the Appeals ...P.O. Box 16275 Reading, PA 19612-6275 Bright HealthCare Claims PO Box 211502 Eagan, MN 55121 EDI Payer ID: BRGHT Bright HealthCare Claims PO Box 211502 Eagan, MN 55121 EDI Payer ID: BRGHT Thank you for your commitment to our members and your patients. We appreciate all you do to help make healthcare right. Together. Title: PY22_Mar-Fax-Prov-PA ...P.O. Box 211256 Eagan, MN 55121 . Mail Forms and Payments. Direct Premium Payments. Univera Healthcare P.O. Box 5267 Binghamton, NY 13902-5267. Claims & Membership Forms.The city for 55121 is usually the name of the main post office. When mailing your package or letter, always include the preferred or acceptable cities. Using any city in the list of unacceptable cities may result in delays. Primary/preferred city: Saint Paul, MN Acceptable: Eagan Stats and Demographics for the 55121 ZIP CodeP.O. Box 211468 Eagan, MN 55121 • Filing deadline is 90 days from the date of service. • Professional services (CPT) must be submitted on a CMS-1500 claim form. • Inpatient services must be submitted on a UB-04 claim form. • Handwritten submissions will be rejected. • Do not use labels, stickers, or stamps on the claim form.PO Box 21146 Eagan, MN 55121-0146 ExcellusBCBS.com . FORM - MXCNY. MEDICARE ELIGIBILITY FORM . Group Number: Group Name: Subscriber ID Number: Member Name: CHECK ONE STATEMENT THAT REPRESENTS YOUR TOTAL EMPLOYEE POPULATION: _____Employs 20 or lessPO Box 211256 Eagan, MN 55121-2656 UniveraHealthcare.com. MEDICARE ELIGIBILITY FORM . Group Number: Group Name: Subscriber ID Number: Member Name: CHECK ONE STATEMENT THAT REPRESENTS YOUR TOTAL EMPLOYEE POPULATION: _____Employs 20 or less _____Employs 20 or moreBetter Living Now - Health Care Products, Programs and Services. Entrust Address: Attn Claims PO Box 211348 Eagan,, PO Box 211095 Eagan, MN 55121 ELECTRONIC CLAIMS SUBMISSION EDI Payer ID: 58375 Professional, Institutional and, Claims Submissions. Two ways to submit claims: EDI-SA001. Mail: Signature Advant, PO Box 211543 Eagan, MN 55121. If owner forbearing has an Aetna icon on my ID card and an 8-digit, mailed to: Mutual of Omaha PO Box 211472 Eagan, MN 55121 Q. Where can I submit a change of, P.O. Box 21099 Eagan, MN 55121. AUTHORIZATION REQUESTS. S, PO Box 211404 Eagan, MN, 55121. Attachment/Appeal Fax# , Perennial Advantage of Ohio: PAOH1. For claims questions, contact us , PO Box 211256 Eagan, MN 55121- 2656 UniveraHealthcare.c, P.O. Box 21099 . Eagan, MN 55121 . Claims sent to any other , P.O. Box 21660, Eagan, MN 55121-0660 Fax: 402-496-8199 How to file a, PO Box 21146 Eagan, MN 55121 Travel and Lodging Reim, Eagan, MN 55121: 844-990-0255: Company Network Type of C, While we highly encourage electronic claim submissions, , Mercy Benefit Administrators. Mercy is changing the healthcare expe, There, claims submission information is broken out by prefix/product, Mail disputes to: Provider Disputes, PO Box 211624, D9810_BCO1 YOUR MEMBER HANDBOOK HAS BEEN CHANGED TO INCL.