Filing a Claim
Remember, you are not required to file any claims when you use an MHN network provider. Click here for additional reasons to use a network provider.
When you visit an out-of-network provider, you usually have to pay the provider's bill at the time of service and then file a claim for reimbursement.
Please complete one of the below forms and attach fully itemized bills and proof of payment. If you don't have both an itemized bill and proof of payment, please ask your health care practitioner to complete Step 2 (health care practitioner statement) of the form. Please send the completed form with all attachments to the claims submission address listed on the claim form.
- If you are an Arizona (AZ) member, download a copy of the Medicare Claim form AZ (pdf)
- If you are a Medicare member, download a copy of the Medicare Claim Form (pdf)
- If you are a Non-Medicare member, download a copy of the Commercial claim form (PDF).
- Before you complete the form, please read these detailed instructions in full. Claims that are not filled out completely may be contested or denied.