Administrative Support
- Claims
- Bills
- Enrollments, Terminations & Coverage Changes
- Supplies
- COBRA Questions
- Miscellaneous Questions or Comments
For the quickest service, please provide us with the following information:
| Name: | Phone: | ||
| Fax: | E-mail: | ||
| Grp Name: | Grp Number: |
| CLAIMS |
| Date of Service: | Provider’s Name: | ||
| Patient’s Name: | Patient’s ID#: |
My claim was denied
Fax/e-mail us a copy of your Explanation of Benefits or doctor’s bill to us
at (703) 273-3556 and we will contact the Claims Dept. for you
to get the situation resolved.
My doctor has received no response from my
insurance carrier on a claim that was submitted
Call us at (703) 273-2069 or e-mail us with the details and we will contact the Claims Dept. and/or the doctor’s office for you.Please get back to me on the following claims issue:
| BILLS |
| Billing Month: | |
| Date of Invoice: |
Credit was not given for last payment
Call us at (703) 273-2069 or e-mail us with the amount
and date paid and we will contact the Billing Dept. for you
or Pay the stated amount on your Bill and your next statement
will be credited or charged back for the appropriate amount.
Please get back to me on the following issue:
| ENROLLMENTS, TERMINATIONS & COVERAGE CHANGES |
| Employee Name: | Empl. S.S.#: | ||
| Eff. or Term. Date: | Reason: |
Enrollment / New Hire
Fax/e-mail us the Enrollment Form for processing at (703) 273-3556.
*Note: Please remember the Employee must satisfy the
“waiting period” you selected when you initially
started the plan. You may change this “waiting period”
at your renewal.
Please cancel the above employee from my group plan
E-mail/Call us at (703) 273-2069 with date of termination.
*Note: Contact us for exact process for the particular carrier
you selected. Each carrier has a different process.
Coverage change for an existing employee
Fax/e-mail us the Coverage Change Form / Enrollment Form for
processing at (703) 273-3556.
*Note: There must be a “Qualifying Event” to make changes
to your coverage i.e. (birth, adoption, marriage, child custody,
spouse lost other coverage, etc.). Please call us at
(703) 273-2069 if you have any questions.
New employee has not received his cards
Call us at (703) 273-2069 so that we may verify enrollment.
Please get back to me on the following issue: