Submit 2016 Empire Plan claims by April 30
By Lorraine Simpkins
If the Empire Plan is your primary insurer, April 30, 2017 (120 days after the end of the calendar year), is the last day to submit your 2016 claims if you have used a non-participating provider or out-of-network pharmacy.
If The Empire Plan is your secondary insurer, you must submit claims by April 30, 2017, or within 120 days after your primary health insurance plan processes your claim, whichever is later.
You may submit claims later if it was not reasonably possible to meet the deadlines (for example, due to illness); however, you must provide documentation.
To obtain non-participating provider claim forms, ask your agency health benefits administrator or find them online at http://www.cs.ny.gov/employee-benefits. Just follow the prompts there to access NYSHIP Online and select Forms. Or, call 877-7-NYSHIP (877-769-7447) and choose the appropriate program.
Submit completed claim forms with supporting bills, receipts and, if applicable, a Medicare summary notice or statement from your other primary plan as follows:
• The Empire Plan Basic Medical Program, the Home Care Advocacy Program (HCAP) and non-network physical medicine services:
UnitedHealthcare Insurance Co. of New York
P.O. Box 1600
Kingston, NY 12402-1600
Claims submission fax: 845-336-7716
Online claim submission: https://nyrmo.optummessenger.com/public/opensubmit
• Non-network mental health and substance abuse services:
Beacon Health Options, Inc.
P.O. Box 1800
Latham, NY 12110
Claims submission fax: 855-378-8309
Online claim submission: https://ets.valueoptions.com/OnlineClaimSubmission
• Prescriptions filled in 2016 at non-network pharmacies or without using your Empire Plan Benefit Card:
P.O. Box 52136
Phoenix, AZ 85072-2136.
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