Get Nova Healthcare Claims Address

Filling out the Nova Healthcare Claims Address form can be a straightforward process when approached with clear guidance. This form is essential for submitting claims related to healthcare services provided to you or your dependents.

Follow the steps to accurately complete your claim form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the group number and the name of your employer in the designated fields. Ensure accuracy to avoid processing delays.
3. Provide your social security number. If you have unreimbursed expenses to apply to a Flex Account, indicate 'Yes' or 'No' in that section.
4. Fill in your full name as the cardholder or employee and complete your address including number, street, city, state, and zip code.
5. Indicate your employee status by selecting from the options available: Active, Retired, COBRA, or Terminated, as well as your marital status.
6. Input your phone number and birthdate in the specified fields.
7. For claims pertaining to dependents, fill in the name, birthdate, and relationship of each dependent in the appropriate lines provided.
8. Complete the section regarding any other insurance coverage by answering the questions about whether you or family members are covered by another group health plan or Medicare.
9. If applicable, answer questions regarding any accidents or injuries that relate to the claim. Fill in the date if an accident occurred.
10. Review the authorization sections for payment and information release, and ensure you sign and date where required as the cardholder/employee and patient.
11. Confirm that all claims statements are accurate and complete. Sign and date the section confirming this.
12. Attach any required items such as an itemized bill, patient name, date of services, diagnosis, procedure code, and provider's tax ID number.
13. Once you have completed and reviewed the form, save your changes, and then download, print, or share the form as necessary before mailing it to the specified Nova Healthcare address.

Take a moment to carefully complete your claims form online for prompt processing.