Get Montana University System Authorized Claim 2018-2026
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How to fill out the Montana University System Authorized Claim online
This guide provides detailed instructions on how to complete the Montana University System Authorized Claim form online. With clear steps and supportive language, users can navigate the process effectively, ensuring that they accurately submit their claims for reimbursement.
Follow the steps to successfully complete your claim submission.
- Press ‘Get Form’ button to access the Montana University System Authorized Claim form and open it in your chosen document editor.
- Fill out the required personal information section, including your name, birth date, insurance card member ID, address, and email address. Ensure all provided information is accurate to avoid delays.
- Identify the claims administrator associated with your health insurance by selecting from Allegiance, BCBS, or PacificSource.
- Confirm that all reimbursable items were pre-authorized by a Take Control Health Coach. This step is crucial to ensure eligibility for reimbursement.
- Check the relevant box(es) to indicate the type(s) of reimbursement you are submitting. Options include Pre-Authorization Request or Reimbursement Request. Note that all providers must be in-network.
- For the medical office visit, enter the visit date and provider name. If applicable, provide similar information for additional counseling visits by listing the provider name.
- If claiming for fitness membership or personal trainer reimbursement, include the relevant details as specified in the instructions. Remember, limits apply based on your enrollment date.
- For any indicated items, list the names, dates, descriptions, and amounts on the provided table section. Ensure you circle the items on the receipts that correspond with the claims.
- Calculate the total claim amount, by following the guidelines for reimbursable items indicated in the form. Enter the total claim amount in the designated field.
- Once all sections of the form are completed accurately, submit the document by faxing it to 406-449-9170, emailing it to kshields@montana.edu, or mailing it to Kelley Shields, MUS Benefits, PO Box 203203, Helena, MT 59620.
Take the next step in completing your reimbursement process by filling out the Montana University System Authorized Claim form online today.
The University of Montana has a moderately selective admission process. While meeting the GPA requirement is important, the holistic review approach means that other elements play a role in admission decisions. Students demonstrate their passion and potential through letters of recommendation and personal essays. For those considering the Montana University System Authorized Claim, it is worth preparing a well-rounded application that showcases your strengths.