Instructions for Submitting a Blanket Accident Claim
A claim form must be submitted for each individual accident/sickness as soon as possible, but in all cases, within 90 days of the occurrence. A fully completed claim form is not necessary when submitting additional medical bills; only one claim form is needed per accident/sickness. Please use a separate sheet of paper to answer any questions that require more space than what is allotted for in this form. Any separate sheet must also be signed and dated by the person providing the information. This form should be obtained from the Policyholder.
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 providers to submit all medical bills along with the corresponding Explanation of Benefits (EOB) from the primary insurance. The bills must be itemized for all services. A physician’s office should submit an invoice utilizing a CMS 1500. A hospital and/or emergency room should submit an invoice utilizing a UB04 (CMS 1500 and UB04 are universal billing forms supplied by the physician’s office and/or hospital).
If the provider will not submit the bill(s) directly, please request these forms from the provider(s). A balance due or patient statement is not acceptable and will only delay processing.
Requests for Additional Information
In the event that a claim is not submitted in full, or if additional information is needed, the claim will be marked incomplete, and the additional information will be requested via US Mail. Please forward the requested information immediately so that we may finish adjudicating your claim in a swift manner. The explanation of benefits form advising what is needed will be sent to the address of the claimant listed on the claim form.
Medicare Requirements
You must answer the questions related to Medicare on the claim form (Section E) and provide the last 5 digits of your Social Security Number (SSN) if you have one. Medicare is a U.S. federal health insurance program created primarily for US citizens, and legal permanent residents who have lived in the US for more than 5 years, who are age 65 and older, as well as certain younger people with certain long term medical conditions or disabilities.
Claim Submission Checklist
Use the checklist below to assure a properly submitted medical claim is being sent:
______Is the claim form completed in full by the claimant and signed? ** Submit the claim form ASAP **
______For Excess Policies Only: If the claimant has primary health insurance, has the claim been submitted first to the primary health insurance?
______For Excess Policies Only: If claim has first been submitted to the primary health insurance coverage, are copies of primary insurance EOBs (explanation of benefits) attached?
______If bills are attached, are they in either a CMS 1500 or UB04 form?
______If any payment has been made by the patient, proof of payment must be included, or payment will be made to the provider (doctor or hospital). **NOTE: Policies are set up to pay all providers directly.
______Have you answered all the Medicare-related questions and, if you have one, provided your SSN, on the claim form?
Send all information to:
Cambridge Administrators LLC Email: info@CambridgeAdministrators.com
5832 S 142nd St, Ste A Fax: (402)504-6447
Omaha NE 68137