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How to submit a claim

Need to submit a claim for reimbursement from medical or dental services? We're here to help.

When should you submit a claim?

You might need to submit a claim when you:

  • Visit an out-of-network provider
  • Receive medical services in another country (use the international claim form) or while on a cruise ship (use the member claim form)
  • You’re being reimbursed for vision or prescription products or services1

You might not need to submit a claim when you:

  • Visit a North Carolina hospital for services or emergency care. If they have your insurance information, they'll file your claim for you.
  • Use an in-network doctor. Need help finding an in-network provider? Try our Find Care tool.

Here's what to include with your claim


To avoid delays and have your claims processed accurately, be sure you submit all of the following:2

  1. A claim form - signed and completed for each member or patient who received care.
  2. A receipt -  Your doctor will give you an itemized receipt for all the services you received. You should submit the original (not a copy) with your claim.
  3. Valid procedure codes -  For example, 99203 is the code for an office or outpatient visit for evaluation. Get these codes from your doctor.
    • Get a different procedure code for each service, and
    • Get a separate charge for each procedure code                  
  4. A diagnosis code for services or supplies. Get these codes from your doctor.

Did you visit an out-of-state provider?

You should also provide this information from the referring provider and the provider you saw:

  1. Name and address
  2. NPI
  3. Tax ID number

Claim forms