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MEDLINK CLAIMS
- Use claim form C101.
- Complete the section entitled "Claimant's Statement". Please be sure to date and sign in the blanks provided at the bottom of the form.
- The Explanations of Benefits from your primary insurance carrier must be submitted.
- A uniform itemized hospital bill (form UB-92) must be submitted for inpatient and outpatient hospital claims.
- The physician's itemized statement of services rendered must accompany the claim form when filing for the Physician Outpatient Treatment Benefit. An Explanation of Benefits is not necessary when filing for this benefit.
< Return to Main Claims Page
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