Claims Research Requests Now Hiring State-Wide Make A Referral Areas We Serve Frequent Questions Make A Payment Did you receive a denial of claim?* Yes No Because some insurance companies only allow claims to be submitted up to 90 days after the date of service, all claim research submissions must fall within 45 days after transmission but less than 90 days after the Date of Service. This will help reduce the number of denials you receive due to timely filing. Thank you. All insurance companies have 45 days to process claims after they have received them. We transmit claims on Wednesdays. DO NOT submit this form if it has not been more than 45 days past the Wednesday after you turned in your billing.* I verify it has been more than 45 days since these claims were transmitted and less than 90 days since the date of serviceAll insurance companies have 45 days to process claims after they have received them. We transmit claims on Wednesdays. DO NOT submit this form if it has not been more than 45 days past the Wednesday after you turned in your billing. Please fill out one form per client for claims that need to be researched. You can enter as many dates of service as needed for that client in a single form but fill out separate forms for different clients. Client First Name*First 5 Letters of Client Name*INSURANCE ID Number*Enter Client INSURANCE ID from THClient Insurance Provider Medicaid - Aetna Better Health Medicaid - Humana Healthy Horizons Medicaid - Oklahoma Complete Health Medicaid - Original Aetna - Commercial Alliance Coal Allied National BlueCross Blue Shield ChampVA Cigna EAP Services Cigna Health and Life Insurance Co. Edison Health Solutions GPA Group Benefit Services (GBS) Health Smart Healthcare Highways HealthCare Solutions Group HealthChoice HealthScope HealthSmart HealthSmart Benefit Solutions HumanaChoice PPO Humana Military Medica Medicare - Aetna Coventry Medicare - Humana Medicare - Other Supplemental Plan Medicare - Original Meritain Health OPTUM VA The Kempton Group Tricare East UMR - Wausau/UHIS United Health Care/United Behavioral Health UHC Medicare WebTPA Other This field is hidden when viewing the formClient Insurance ProviderEnter the client's insurance provider that should have made paymentDate of Service in Question* MM slash DD slash YYYY Do you have more dates to report for this same client?*Select OneYesNoAdditional Date of Service in Question* MM slash DD slash YYYY Must be for the same client Additional Date of Service in Question MM slash DD slash YYYY Must be for the same client Additional Date of Service in Question MM slash DD slash YYYY Must be for the same client Additional Date of Service in Question MM slash DD slash YYYY Must be for the same client Additional Date of Service in Question MM slash DD slash YYYY Must be for the same client . If you have more than 5 dates for one client, please submit additional forms. Please provide any information you think might be helpfulClinician Name*Clinician Email Address* Verification* I verify that I have reviewed payroll data before submitting this form.By checking this box you verify that you have reviewed your paystub to ensure you did not receive payment. If multiple forms are submitted by you and we find the payment on your paystub, your requests will be sent to the bottom of our work queue. Δ
