Get Sharp Claim Reimbursement Request Form This Form To Be - Adventistretirement

The SHARP Claim Reimbursement Request Form is designed to facilitate the reimbursement process for various healthcare services covered under the Adventist Retirement plan. This guide provides detailed, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click the ‘Get Form’ button to download the SHARP Claim Reimbursement Request Form and open it in your preferred document editor.
2. Select the type of claim you are submitting by checking the appropriate box. Options include Dental, Vision, Hearing Aid, Chiropractic, or Other.
3. Provide the Group Information by filling in the Group Name as 'SHARP (Supplemental Healthcare Adventist Retirement Plan)' and the Group Number '100110'.
4. Enter the Retiree and Member Information. Fill in the Retiree’s Name, Patient’s Name, Patient’s Birth Date, and Member Number in the designated fields.
5. Choose how you would like the reimbursement to be processed by selecting either to 'Pay Retiree' or 'Pay Provider'.
6. Review the important notes to ensure you have the correct reimbursement request form and provide the required original bills from the healthcare provider.
7. After completing all sections, save your changes and prepare to print or share the form as required, along with all supporting documentation.
8. Mail the completed form and necessary receipts to Adventist Risk Management Inc., PO Box 1928, Grapevine, TX 76099-1928, or fax to 469-417-1760.

Complete your SHARP Claim Reimbursement Request Form online today for a seamless processing experience.