Claim Form only needed if provider does not submit claim. The University of Idaho toll free phone number is 1-800-767-0700. Box 2415 Grapevine, TX 76099-2415 . Customer Service agents are available Monday through Friday, 7:00 AM to 7:00 PM Central Standard Time (5:00 AM to 5:00 PM Pacific Standard Time). P.O. Mail to: United Healthcare Student Resources PO Box 809025 Dallas, TX 75380-9025 Fax to: 469-229-5625 Email to: [email protected] Prescriptions Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475, 800-800-7616. Paid by card – Please provide a bank statement that includes your personal information and the care provider information. Hard Copy Submission – Provider or Student may mail to: If the student does not have his/her ID card when filling a prescription, an Optum Rx pharmacy has up to 30 days to electronically file the claim. AXIS PROFESSIONAL LABS LLC can be reached at his practice location using the following numbers: Phone: 469-995-7792 Fax: 469-995-8238 The provider's official mailing address is: PO BOX 803525 DALLAS, TX 75380-3525, US The contact numbers associated with the mailing address are: PHONE. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. Univ. Dallas, TX 75380-9025 The response will include what the findings were if the appeal was approved or denied, and the reason for the final decision. FAX (469) 417-1969. If you are a student and would like to check on the status of a claim that you or a provider submitted, you will need to set up a My Account if you have not done so already. PHONE. PO Box 809025 Dallas, TX 75380-9025 Electronic Payer ID #: 74227 NOTICE TO ALL HEALTHCARE PROVIDERS This card is not a guarantee of coverage. You do not need an additional claims form. His current practice location address is 7777 Forest Ln Ste C655, , Dallas, Texas and he can be reached out via phone at 972-566-5212 and via fax at 972-566-2372. of Colorado – Anschutz Medical Campus 2019-202512-1 Massage Therapy Reimbursement Form Instructions: Please complete form and submit with proof of payment for services rendered within 90 days of the Date of Service. Box 809025, Dallas, Texas 75380-9025 Customer Service: 1-800-767-0700 NOTICE REGARDING TRANSLATOR AND INTERPRETATION SERVICES We provide, upon request, interpreter and translation services related to administrative procedures and claims processing. CLAIMANT INFORMATION . PO Box 809025 Dallas, TX 75380-9025. Phone Number . Providers in network with CareFirst should mail claims direct to Carefirst for pricing. Submit claim to UnitedHealthcare StudentResources PO Box 809025 Dallas, TX 75380 … staple, all bills to the completed form. For Terms and Conditions, click here. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. The RX Bin #), PCN # and Group #  along with the student’s individual 7-digit ID number will need to be entered. We provide cost-effective, comprehensive insurance plans. What's 75380-9099? Box 809025 Or the student can pay for the prescription and file for reimbursement using an Optum Rx Reimbursement Claim Form. Download Form; Back to Top. P.O. PO Box 809025 Dallas, TX 75380-9025. PO BOX 981633 EL PASO TX 79998-1633 WWW.CAREFIRST.COM 1-800-235-5160. Plan Administration UnitedHealthcare StudentResources 2301 West Plano Parkway, Suite 300 Plano, TX 75075 Mail your claims to: UnitedHealthcare StudentResources P.O. School Administrators - Partner Center Support: 1-888-754-8089 Students - Customer Service: 1-800-767-0700 MAIL. 809025 If you have any concerns regarding your processed claims, you can always issue an appeal. 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