Homepage
About Us
Contact Us
Site Map
>
Customer Service
>
Claim Forms & Instructions
>
Change & Request Forms
>
FAQ for Customers
>
FAQ for Employers
>
Find a Beech Street Doctor
>
Find a Beech Street Hospital/Facility
>
Broker Services
>
Secured Online Services
>
Convention Standings
>
Download Forms
>
Underwriting Guidelines
>
News and Alerts
>
Request Report or Bill
>
Order Supplies & Sales Materials
>
Group Dental Plans and Quote Requests
>
Provider Services
>
How to Confirm Coverage
>
Billing Information
>
Broker Opportunities
>
APL Product Information
>
Get Appointed
>
Solutions For Employers
>
Available Benefits
>
Contact APL
>
HIPAA Privacy Notice

Claim Forms & Instructions

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
  Privacy Policy   -   Terms of Use   -   Licensing © Copyright American Public Life 2003  

® American Public Life is a Registered Trademark