Peia Medical Claim Form

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Forms & Downloads - West Virginia

http://peia.wv.gov/Forms-Downloads

PEIA is required by law to maintain the confidentiality, privacy, and security of our members’ protected health information (PHI). ... Health Plans. PPB Plans A, B & D; PPB Plan C; …

Find a Form or Document - West Virginia

https://peia.wv.gov/find-a-form-or-document/Pages/default.aspx

Maternity Benefit Pre-Pay ment Form. Medical Claim Form Medical Travel Expense Reimbursement Request Form. Mountaineer Flexible Benefits Enrollment Form (Active …

See back of form for complete claim filing …

https://peia.wv.gov/Forms-Downloads/Documents/ppb_plans/providers/Medical_Claim_Form.pdf

claim form. Claim address listed on the bottom of the claim form is for member use only; providers should bill to the address on the member ID card. This fax number also …

How to File a Medical Claim - West Virginia

https://peia.wv.gov/understand_my_benefits/preferred-provider-benefit-plans-a-b-d/claims-and-appeals/Pages/How-to-File-a-Medical-Claim.aspx

How to File a Medical Claim. Medical claims are processed by UMR and should be submitted to: UMR, P.O. Box 30541, Salt Lake City, UT, 84130-0541. This post office box …

PEIA

http://peia.wv.gov/

Marriage. Retirement. Non-State Agency Enrollment & Withdrawal. New Employee. Video Library. Administrative Hearings Process. Health Care Forms for Tax Purposes. Contact …

How to Appeal a Medical Claim - West Virginia

https://peia.wv.gov/understand_my_benefits/preferred-provider-benefit-plans-a-b-d/claims-and-appeals/Pages/How-to-Appeal-a-Medical-Claim.aspx

UMR. 1-888-440-7342. UMR. P.O. Box 30541. Salt Lake City, UT 84130-0541. If your medical claim or service has been denied, or if you disagree with the determination …

UMR - West Virginia

https://peia.wv.gov/Pages/UMR.aspx

your ID card using UMR's desktop or mobile sites. What is UMR Disease Management? Check out this video to learn more about this free member program and you can make …

Contact PEIA - West Virginia

https://peia.wv.gov/contact_peia/Pages/default.aspx

[email protected]

Health Reimbursement Account (HRA) Claim form - UMR

https://fhs.umr.com/oss/cms/FHS.UMR.com/SharedFiles/AD1149.pdf

Health Reimbursement Account (HRA) Claim form . How to complete the form • Complete sections A, B and C. • Attach an Explanation of Benefits (EOB) from the insurance …

UMR Portal

https://provider.umr.com/

UMR is a third-party administrator (TPA), hired by your employer, to help ensure that your claims are paid correctly so that your health care costs can be kept to a minimum and …

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