Policies with Excess Coverage
Eligible covered expenses will be paid only if they are in excess of other valid and collectible insurance or medical payment plan. If the claimant is covered by any other health insurance or medical payment plan, the provider must first submit the claim to the primary insurance. After the primary insurance has paid benefits, they can then submit the itemized bill along with the corresponding Explanation of Benefits (EOB) from the primary insurance to Cambridge Administrators.
Policies with Primary Coverage
Eligible covered expenses will be paid regardless of other insurance. There is no need for the provider to submit claim to any other insurance prior to submitting to Cambridge Administrators.
Medical Bills
Please ask your provider to submit all itemized medical bills related to the accident / injury. Instruct the providers to include the policy number and/or Policy Holder name for identification. A balance due statement cannot be accepted and will delay processing. A physician’s office should submit a CMS 1500 (HCFA 1500) billing form. A hospital and/or emergency room should submit a UB04 billing form. CMS1500 (HCFA 1500) and UB04 are universal billing forms supplied by the physician’s office and/or hospital.
Requests for Additional Information
In the event that a claim is not submitted in full or if additional information is needed, the additional information will be requested via US Mail. Please forward the requested information immediately, so that we may finish processing your claim without delay. If no response is received, the claim will be closed, and will remain closed until the information has been received.
Claim Checklist
The below checklist should be used to assist you when filing a claim:
______Has on-line incident report been completed in full? If not authorized to use the on-line incident report, has the paper claim form been completed in full and submitted?
______For Excess Policies Only: If the athlete has primary insurance, were bills first submitted to the primary insurance?
______For Excess Policies Only: If primary insurance exists, are copies of the primary insurance EOBs (explanation of benefits) regardless of payment or denial?
______Are the bills itemized (in either CMS 1500 or UB04 form), and do they include the Policy Number and / or Policy Holder Name?
Send all information to:
Cambridge Administrators LLC
5832 S 142nd St, Ste A
Omaha NE 68137