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PO Box 2920 Clinton, IA 52733-2920 THIS SIDE OF THE FORM MUST BE COMPLETED IN FULL. Attach this form to itemized bills for all expenses being claimed. The bills must show: Patient's Name, Type of Service, Date(s) of Service(s), and the Total Charge. If you are submitting a surgical bill of if the bills are for a major illness,PO Box 2920 Clinton, IA 52733-2920 THIS SIDE OF THE FORM MUST BE COMPLETED IN FULL. Attach this form to itemized bills for all expenses being claimed. The bills must show: Patient's Name, Type of Service, Date(s) of Service(s), and the Total Charge. If you are submitting a surgical bill of if the bills are for a major illness,Administered by: Sun Life Financial PO Box 2941 Clinton Iowa 52733 KC2147ANY (10/2016) 14-a Employee/subscriber name (if different than patient's) 14-b Employee/subscriber Soc. Sec. or I.D. no. 14-c birthdate MO DAY YR 15 Relationship to patient Self Parent Spouse Other 11 12-aIs patient covered by another dental plan? Yes No

Medical Care. Trustmark. Phone: 866.893.4472. Address: Trustmark Health Benefits, P.O Box 2920, Clinton, IA 52733-2920. Trustmark Home Page. 2022 PMSD Summary of Benefits & Coverage. PMSD Summary of Medical Plan. Physician Providers Search Office Visit $15 Specialist $45. Urgent Care Provider Search $40.Falls Lake Insurance. P.O. Box 4254. Clinton, IA 52733-4205. To find a medical provider: www.coventrywcs.com. Medical Providers Only: If you have any questions about how your medical bill was processed, contact Coventry Workers' Comp Services directly: (800) 937-6824 . Find all of the information and contact that you need to submit a Workers ...Zip Code 52733 Map. Zip code 52733 is located mostly in Clinton County, IA.This postal code encompasses addresses in the city of Clinton, IA.Find directions to 52733, browse local businesses, landmarks, get current traffic estimates, road conditions, and more.. Nearby zip codes include 52734, 52732, 61252, 61230, 52730.Clinton, IA has 2 Standard (Non-Unique), 1 PO Box, and 2 Unique ZIP Codes. Together, these cover a total of 111.34 square miles of land area and 9.28 square miles of water area.This includes the Elvira, Hauntown, Six Mile and Clintonareas. A full list of ZIP Codes is below, including type, population and aliases for each.Accredited. Business. (563) 503-5818. 239 5th Ave S. Clinton, IA 52732. CLOSED NOW. From Business: The Insurance Agency of Ken Kroemer Insurance has been providing the Clinton metro and surrounding areas of Iowa and Illinois with quality insurance for over 40…. 5. UnitedHealthcare.

P.O. Box 4387 Clinton, IA 52733 Part A - Patient & Employee Information 1. Patient name 2. Relationship to employee 3. Sex self wife husband daughter M son stepchild foster child F 4. Patient birth date (mo/day/year) 5. If full-time student School City 6. Employee name (first/middle/last) 7. Employee's social security number 8.Medical Bill Reconsideration or Appeal. To submit a corrected claim or reconsideration, the bill must be labeled “RECONSIDERATION” with a copy of the original Explanation of Review (EOR) and any supporting documentation. Submit all Medical Bill Reconsiderations to: Key Risk. PO Box 14817. ….

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City of Clinton 611 S 3rd Street P.O. Box 2958 Clinton, IA 52733-2958 Phone: 563-242-2144PO BOX 2942 CLINTON, IA 52733-2942 Discount Amount Allowed Amount Other Plan Payment Other Adjustments Consolidated Explanation of Benefits This is not a Bill Benefit Explanation Code Claim #: A211111-00 Pat. Acct.: 2111111x11201 17003 - SURGERY - STEPHEN J BECK MD 8/24/2011 232.00 Ineligible CoPay/ Encounter Fee Deductible Coinsurance

P.O. Box 2920 Clinton, IA 52733-2920 Do not submit claims or direct questions to Aetna Signature Administrators. Submitting claims to the network instead of Trustmark will result in payment delays and incorrect denials. Expect. more. Benefit. more. Use myTrustmarkBenefits.com for anytime provider self-service.Get a quote in Clinton, IA. Call The Insurance Group at (563) 242-4000 today.Luminare Health, P.O. Box 2920, Clinton, IA 52733-2920. Do not submit claims or direct questions to. Aetna Signature Administrators. Submitting claims to the network instead of Luminare Health will result in payment delays and incorrect denials.

exceptional place to play tennis crossword Hillary Clinton can be contacted through her website, www.hillaryclinton.com, Twitter, Facebook and Instagram. Contact requests can also be made through her mailing address: Hillar... deer feeding chart for georgiaancient manuscripts discovered in the qumran caves nyt crossword P.O. Box 2977 Gainesville, GA 30503 Benefit Support P.O. Box 2977 Gainesville, GA 30503 Benefit Support 770-532-2690 Managed Care Concepts 866-750-2723 HP (Primary) First Health (Wrap) Habersham County BOC 07/01/2018 $25/$50 Co-Pay HM0000 Trustmark Health Benefits PO Box 2920 Clinton, IA 52733-2920 Trustmark Health Benefits PO Box 2920 lebanon 911 dispatch What you should know before filing a COVID-19 claim. Please include all necessary documentation, such proof of test or service for the claim. Claims submitted without the required forms will no longer be accepted, and may take longer to process. Trustmark Voluntary Benefit Solutions, Inc. is a subsidiary of Trustmark Mutual Holding Company. leggett platt paystub portaltn gov food stampcrystal run healthcare west nyack west nyack ny 10994 Please submit all forementioned with attached medical records related to the dates of service on the bills, including reconsiderations, for bill review to the following address: LWCC. ‍. Attn: Medical Bill Review. PO Box 2939. Clinton, IA 52733. You can also submit your medical bills and supporting documentation electronically through Jopari. woodzeez route 66 dispensary Please submit all forementioned with attached medical records related to the dates of service on the bills, including reconsiderations, for bill review to the following address: LWCC. ‍. Attn: Medical Bill Review. PO Box 2939. Clinton, IA 52733. You can also submit your medical bills and supporting documentation electronically through Jopari.P.O. Box 4387 Clinton, IA 52733 Attending Dentist's Statement Please mail completed form to the address above. For questions, please refer to the Benefit Phone # on your ID card. ... Place of treatment (check applicable box) 39. Number of enclosures (00 to 99) provider's office ECF hospital other photographs(s) oral image(s) model(s) 40. Is ... 2005 honda odyssey ac relay locationsams gas price novicharles from tmz net worth Find and Insurance Provider Near Me. Home; Who We Are; Support; © 2024 InsuranceDept.org | All Rights Reserved; Terms of ServicePO Box 2934 • Clinton, IA 52733-2934 • Fax 847-621-7101. Reverse side must be completed if applicable before submission to Tristar . ADDITIONAL DETAILS HOW INJURY OCCURRED: PREVIOUS INJURIES OR ILLNESSES . DATE(S) OF : INJURY/ILLNESS DESCRIBE INJURY/ILLNESS WAS THIS WORKERS’