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All the forms you need to submit are available as a free download, or you can submit your bills and forms online via the Member Portal. These forms are the Needs Processing Form (both sides), the Medical Release Form, the Letter of Explanation and the Prayer Page Request Form (the last form should be sent to CHM only if the treatment was for a pre-existing condition). Alternatively, you can call the Needs Processing department at 1-800-791-6225 and ask that forms be sent to you by mail. It’s important that each form is filled out and submitted promptly to the address listed on the top of each form; missing forms will result in a delay in sharing your bills.
Do this even if a discount is still pending. The sooner CHM receives the bill, the sooner the bill can be shared and the faster you can pay your medical providers. You can always let CHM know about a discount later when it has been approved by your doctor or hospital. For bills to be eligible for sharing, CHM must receive bills within six months of the date of service. An itemized bill contains: 1) the patient’s name; 2) the date of service; 3) the place of service; 4) the procedural (CPT) codes for services rendered; 5) an itemized list of charges.
If obtaining itemized bills is a challenge, CHM can instead accept a CMS-1450 or UB-04 from your hospital or a CMS-1500 (formerly HCFA-1500) from your doctor—these are standardized billing forms used by health care providers. If your provider seems puzzled by what information, exactly, CHM needs to process your medical bills, please tell them that these standardized forms contain the exact information we need. If you still need help getting an itemized bill, contact CHM at 1-800-791-6225.
For members with Medicare only: Please submit your Medicare Summary Notice (MSN) in lieu of itemized bills. (We also need a copy of the EOB from any health insurance plan you may have). The only exceptions—situations in which you’d need to send itemized bills—are prescriptions and any bills from non-Medicare participating providers. (If your healthcare provider doesn’t accept Medicare, you’ll have to file a CMS 1490S form with Medicare and send CHM your updated Medicare Summary Notice when you receive it.)
Notify CHM if your provider sets a time limit for reduced charges and the CHM staff will work with your provider to share the bill(s) on time. In general, bills are shared in the order they’re received at the CHM office. Also, the larger the discount given by providers, the faster bills often can be shared.
Treat as reimbursement from CHM (since you will be reimbursed) any portion of the funds you have already paid to your provider(s).
Sometimes called a “Stork Package” or “global fee" these rates often include all pre-natal and delivery charges at a reduced price. (When asking for a hospital prepayment agreement, keep in mind that room and board charges are not always included in the quoted price.) When you have it, submit the agreement to the CHM office and send any additional bills as “add-ons” to the original amount. In most cases, submitting a timely agreement enables CHM to share your maternity bills by the time the baby is born. Be sure to also visit our maternity page.