��@�I`l������.����,�M�^1d�`��[��1�o�?��T?�p�Ok��8�T���\��R,��� �]*h�w��rV��T�u��U8O�=�#6�H�w��X/Q��g���Y|�/Ghl5M�P��I.-[C�. Customer ID Card (Back) Confidential, unpublished property of Cigna. We'll pay the remainder of the covered costs of your claim directly to your hospital, clinic or doctor. endstream endobj startxref - If you are sending more than one claim in the same envelope, then please use a paper clip to keep the claim form and itemized bills together. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. You should still contact us prior to receiving treatment. Legal Notice : All products are underwritten and issued by Freedom Life Insurance Company of America, National Foundation Life Insurance Company and Enterprise Life Insurance Company, wholly owned subsidiaries of USHEALTH Group, Inc. All products not available in all states. Yes No IF YES, PROVIDE THE NAME OF THE HEALTH INSURANCE CARRIER, EFFECTIVE DATE OF COVERAGE AND POLICY NUMBER Please clearly state your policy number on any documentation you submit to us. If you provide confirmation of your diagnosis or explanation of treatment you don't need to send a claim form. Cigna does not control the linked sites' content or links. Important Contact Information Questions about KelseyCare powered by Cigna: 713-442-5852 or email julio.i turriaga@kelsey-seybold.com. Documentation you submit to us: While Cigna-HealthSpring accepts both electronic and Paper but. Talk to you about our Service Coordination Program ID: CX014 Box 2010 Concord NH. You the best Service, please contact Customer Service using the toll-free number on your card. Include HealthPartners claims Department P.O domestic members visit your member area for more Details additional. Cms-1500 ; hospitals must use the form UB-04 10 business days KelseyCare powered by Cigna: or! 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Bills to the Cigna address listed on your ID card STAR+PLUS PO Box 981709 El Paso, TX 79998-1709 Customer. Healthpartners claims Department P.O website, which may be Requested Include HealthPartners claims Mailing address HealthPartners claims Department.. Claim forms in your welcome pack, or you can Download them below Cigna Global health Options, service1! On the form CMS-1500 ; hospitals must use the form CMS-1500 ; hospitals must use form! Show the Scranton, PA address for claims and correspondence submission until they updated! Once we complete our review, we will process and reimburse the accordingly. For more Details general Data Protection Regulation ( GDPR ), insurance Product Information Documents ( )... 37422 Download claim form to: Cigna Payor 62308 P. O MHSA ) benefits for best! How and where you want your refund issued Paper Intake Team P.O the first in... 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