837 Health Care Claim – Detailed Invoice From Your Health Care Provider

837 Health Care Claim837 Health Care Claim is a detailed invoice that your health care provider (e.g. your doctor, clinic, or hospital) sends to the health insurer. This invoice shows exactly what services you received. How 837 Health Care Claim works? Here is the procedure of the 837 Health Care Claim operation cycle:

  1. You get a service from a health care provider.
  2. The health care provider submits a claim to your health care plan.
  3. Your health care plan processes the claim according to your plan benefits.  If you have to pay part of the bill, your health care plan will send you a summary. This summary is called an Explanation of Benefits (EOB). It shows exactly what Unity has paid for the service you received. It also shows the amount you may be billed by your health care provider.
  4. Your health care provider will send you a bill for the part of the charges you need to pay, if any.

How to submit a medical claim from a non-participating provider

Sometimes you may get services from a health care provider that is not in your network. In that case, you must send in the claim to health care plan:

  1. Fill out the health care plan Member Claim Form.
  2. Include a copy of the billing statement or claim form received from the doctor, clinic or other provider.
  3. Include receipts and / or proof of payment.

Most health care plans process the 837 Health Care Claim according to your plan benefits. Usually the claim must be mailed to the health care plan within 90 days from the date of the service. Sometimes it is not possible to send the claim within 90 days. In these cases,  health care plan will review claims received within one year of the service.

If you get medical care in another country, you must provide  health care plan a copy of the claim in English. Include any papers that show you got and paid for the health care. You should keep copies and send the originals to  health care plan.

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