How to file a claim via e-mail, mail, or fax
Please follow these steps to file your claim.
1. Fill out a claim form
You can submit a claim by completing the appropriate Claim Form and submitting it via email, fax or mail.
- Download the appropriate claim form:
Each claim form must be legible and all fields must be completed. To ensure all text provided is legible; we suggest completing the form using the free Adobe Reader software. Filling it out in any other software might lead to file corruption when sending it back to us. To download Adobe Reader for free, visit Adobe Acrobat Reader.
2. Compile all the necessary documentation
All your documentation must be legible and submitted in PDF format including receipts, invoices, laboratory results, diagnostic testing and medical records. We encourage you to keep copies, for your records, of all documents provided with your claim form. All invoices must be official and altered documents will not be accepted.
When submitting relevant documents:
- Separate receipts and itemized bills if more than one (1) claimant
- If you are filing a claim from a medical provider in Mexico, you must submit a “Factura Electrónica” also referred to as a “Comprobante Fiscal Digital (CFDI)” or “Factura Fiscal”, which is an electronic invoice that serves as an electronic tax receipt (required by Mexican authorities)
- Completed a separate Claim Form for each claimant with appropriate receipts and itemized bills attached
- Doctor’s invoices/bills must include:
- Medical providers name, address, and signature
- Claimant’s name
- Doctor’s specialty (obstetrics, pediatrics, neurology, etc.)
- Detailed description of service rendered (office visit, surgery, etc.)
- Date(s) of service
- Charge for service / Total amount billed (with proper currency)
- Pharmacy receipts must include:
- Claimant’s name
- Name of prescribing physician
- Name of prescription
- Date(s) of prescription
- Charge for medication
- Pharmacy name, telephone number, and address
Hospital invoices/bills must include:
- Claimant’s name
- Referring/treating physician
- Date of admission and discharge
- Diagnosis/reason for hospitalization
- Itemized hospital bill
- (Note: tax and patient convenience items such as telephone and television are non-covered items)
If a medical laboratory test or diagnostic exam is performed, the results should be included
3. Send your claims package
Once all documents are in order and all the appropriate forms have been completed, please send the claims package to PA Group Administration via email, mail, or fax.
1901 Ponce de Leon Blvd.
Coral Gables, FL 33134 USA
Toll Free: +1 (800) 222-3002
Phone: +1 (786) 667-4800
Fax: +1 (305) 567-0574
4. Review your explanation of benefits
Once your claim has been processed, you can review your Explanation of Benefits. The EOB describes your claims reimbursement including allowable charges, amount applied to the deductible, percentage of reimbursement, and any refused charges. You can view and download the Explanation of Benefits via the member portal.
- Log in to your member portal
Click “Claims” under the “Operations” drop down menu
In the same line as the “Date of Service”, select the appropriate “From” and “To” dates related to the claim you submitted
Once the dates have been selected your claim will appear in the table
Click the icon under the column titled “EOB”
Your EOB will appear, feel free to save to your computer or print and keep for your records
Ready to file a claim?
We are here to assist, guide and support you every step of the way. Please feel free to contact our office at +1 (800) 222-3002 within the U.S. at +1 (786) 667-4800, outside the U.S. or via email at firstname.lastname@example.org with any questions you may have regarding your claim submission.