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  • Please Submit Completed Form To Healthsmart Within 30 Days

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Return to : HealthSmart Benefit Solutions, Inc. Phone: (800) 7866525 FAX: (303) 8049490 Email: PBDenver healthsmart.com Please submit completed form to HealthSmart within 30 days of Qualifying Event.

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75185 837 ✓ ✓ ✓ ✓ Effective immediately, please send all claims for Payer 75185 to HealthSmart Benefit Solutions (EDI Payer ID #37283).

HealthSmart is the premier provider of innovative, customizable and scalable solutions for employers, brokers and payers. Our solutions include health plan benefit administration, care management, pharmacy benefit management, provider networks and casualty claims solutions.

Claims must be filed within two (2) years of incurring the claim expense.

P.O. Box 93670 Lubbock, TX 79493-3670 ENROLLEE: TO AVOID DELAYS, PLEASE FOLLOW THE INSTRUCTIONS BELOW.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232