Provider Quick Reference Guide - MultiPlan <>/Subtype/Form/Type/XObject>>stream 97 0 obj endobj Or fax to (763)-852-5057. Contact us If you have questions about claims or benefits, we're happy to help. xPpurb & Meritain Health Member Services - Meritain Health the cost of care for our plan sponsors and members. <>/Subtype/Form/Type/XObject>>stream endobj endobj 70 0 obj 0000222040 00000 n <>/Subtype/Form/Type/XObject>>stream Aetna Open Choice PPO Network. endobj Claims Mailing Address: Meritain Health PO Box 853921 Richardson, TX 75085-3921 EDI: WebMD/Emdeon 41124 McKesson/Relay Health 1761 Dental Claims Paper Claim Mailing Address: Anthem Dental Claims PO Box 659444 San Antonio, TX 78265-9444 Electronic claims are submitted via payor ID 84105 Dental Claims Inquiries Paper Fax: 314.984.8653 Electronic Fax: 0000030713 00000 n endobj endobj Your signature and your understanding of what it means {For the status of submitted claims. startxref endobj Address, phone number, and practice changes Contact us online Contact us by phone For non-participating health care professionals Network applications (behavioral health, dental, facility, and pharmacy) Practice changes and provider termination Request a medical application Request Part D pharmacy participation Copyright 2023 Meritain Health. <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 124.92 301.56 579.6 323.76]/Subtype/Widget/T(Spouses Employers Address_2)/TU(Spouses Employers Address)/Type/Annot>> 15 0 obj Meritain Health Provider Services - Meritain Health 42 0 obj Provider services - Meritain Health. <>/Subtype/Form/Type/XObject>>stream Meritain Healths claim appeal procedure consists of three levels: There are two forms listed below that a member must complete and give to the provider submitting the formal written appeal. <>/Subtype/Form/Type/XObject>>stream 0000047633 00000 n x PDF Claims Submission and Payment - mbh-eap.com H23U0t.=s#0agf!R@PBLX n xPpurb & 87 0 obj <>/Subtype/Form/Type/XObject>>stream 0000222146 00000 n <> endobj <>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 4 0 R /Rect[ 266.76 352.32 276.84 362.4]/Subtype/Widget/T(Individual)/TU(Individual)/Type/Annot>> endstream 34 0 obj endstream endobj 26 0 obj<> endobj 27 0 obj<> endobj 28 0 obj<>/ColorSpace<>/Font<>/ProcSet[/PDF/Text/ImageC]/ExtGState<>>> endobj 29 0 obj<> endobj 30 0 obj<> endobj 31 0 obj<> endobj 32 0 obj[/ICCBased 38 0 R] endobj 33 0 obj<> endobj 34 0 obj<> endobj 35 0 obj<> endobj 36 0 obj<>stream The form linked below should used by a member who would like to grant permission to another individual to act on their behalfin connection with an appeal.
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