Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Uncategorized Forms
  • Mca Administrators Claims Address

Get Mca Administrators Claims Address

MEDICAL CLAIM FORM CLAIM ASSISTANCE: 1-800-427-9308 MCA ADMINISTRATORS, INC. 1. COMPLETE THIS FORM 2. ATTACH ALL BILLS 3. MAIL TO P.O. BOX 6540 HARRISBURG, PA 17112 ? ADMINISTRATOR FOR AMERICAN MANAGEMENT.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Mca Administrators Claims Address online

Completing the Mca Administrators Claims Address online is an essential step for filing your claim efficiently. This guide will provide clear, step-by-step instructions to help you navigate the form with ease and accuracy.

Follow the steps to complete the form effectively:

  1. Click the ‘Get Form’ button to access the Mca Administrators Claims Address form, allowing you to open it in your preferred editor.
  2. Fill out Part A, which pertains to the policy holder. Provide necessary details such as the name of the school district, address, and contact information. Ensure accuracy in inputting the telephone number and the relevant dates.
  3. Complete the information regarding the injured person, including their name, date of birth, social security number, age, and grade. Be mindful to specify the nature of the injury and provide a detailed description of how it occurred.
  4. In Part B, provide details of the parent, responsible party, or guardian. Include their relationship to the insured, contact information, and employment details.
  5. State whether the injured person has other health insurance coverage and indicate the relevant information about other insurance policies if applicable.
  6. Read through the authorization sections carefully. Sign where indicated to certify that the information provided is accurate and that you agree to the terms outlined in the authorization.
  7. Attach all supporting documentation, including any bills and reports related to the injury. Review everything for completeness and accuracy.
  8. Once all fields are completed, save your changes. You can then download, print, or share the completed form as necessary.

Begin your document submission journey by filling out your claims address online today!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

WV SOS - Business and Licensing - Corporations
Officers. Type, Name/Address. Director, CHARLES DAVIDSON 1910 COCHRAN RD,STE 605,MANOR OAK...
Learn more
Mont. Admin. r. 24.40.801 - CLAIMS FOR BENEFITS
(1) A claimant must file an initial claim by using the online portal, or by calling the...
Learn more
MCO 4400.150 LPC-2
Jan 29, 2014 — (16) Department of Defense Activity Address Code (DoDAAC) Management...
Learn more

Related links form

Student Learning Objectives Michigan Subscription Agreement Form - Vanguard Domestic Relations Financial Affidavit - Home - Ogeecheecircuit Andreas Vaatz

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Electronic Data Interchange (EDI) FCE's Payer Number is 33033.

Please send claims to the following address: Mail to:ACI P.O. Box 4000 Collegeville, PA 19426-9000Fax:610-293-9299EDI Payor ID #:22384

Payer Name: CoreSource (NC, IN)

MCA Administrators, Inc.

Payer List Payer NamePayer IDServicesMCA ADMINISTRATORS25160UB04 1500 ERAMCITJ1351UB04 1500 ERAMcLaren Advantage SNP3833RUB04 1500 ERAMcLaren Health Advantage3833AUB04 1500 ERA96 more rows

The payer ID is generally five (5) characters but it may be longer. It may also be alpha, numeric or a combination. The payer ID is often located on the back of the insurance card in the Provider or Claims Submission section.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Mca Administrators Claims Address
Get form
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
  • Real Estate Handbook
  • All Guides
  • Notarize
  • Incorporation services
  • For Consumers
  • For Small Business
  • For Attorneys
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Form Packages
  • Adoption
  • Bankruptcy
  • Contractors
  • Divorce
  • Home Sales
  • Employment
  • Identity Theft
  • Incorporation
  • Landlord Tenant
  • Living Trust
  • Name Change
  • Personal Planning
  • Small Business
  • Wills & Estates
  • Packages A-Z
Form Categories
  • Affidavits
  • Bankruptcy
  • Bill of Sale
  • Corporate - LLC
  • Divorce
  • Employment
  • Identity Theft
  • Internet Technology
  • Landlord Tenant
  • Living Wills
  • Name Change
  • Power of Attorney
  • Real Estate
  • Small Estates
  • Wills
  • All Forms
  • Forms A-Z
  • Form Library
Customer Service
  • Legal Hub
  • About Us
  • Help Portal
  • Legal Resources
  • Blog
  • Affiliates
  • Contact Us
  • Delete My Account
  • Site Map
  • Industries
  • Forms in Spanish
  • Localized Forms
  • State-specific Forms
  • Forms Kit
Legal Guides
  • Real Estate Handbook
  • All Guides
Prepared for you
  • Notarize
  • Incorporation services
Our Customers
  • For Consumers
  • For Small Business
  • For Attorneys
Our Sites
  • USLegal
  • FormsPass
  • pdfFiller
  • signNow
  • altaFlow
  • DocHub
  • Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
© Copyright 1999-2026 airSlate Legal Forms, Inc. 3720 Flowood Dr, Flowood, Mississippi 39232
  • Your Privacy Choices
  • Terms of Service
  • Privacy Notice
  • Content Takedown Policy
  • Bug Bounty Program