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REIMBURSEMENT to include Non-Emergency Treatment
Download: Inpatient | Outpatient Claim forms
For EMERGENCY | NON-EMERGENCY REIMBURSEMENT
ETIQA Direct: Reimbursement @ ACCREDITED RATE: the rate the doctor/hospital/clinic would have been paid.
PURPLE COW: Reimbursement AS-CHARGED, up to MBL: the rate the Member paid the doctor, hospital, or clinic.
Reimbursement claim must be submitted within 30 days of the date of treatment (consult/discharge)
15-day TAT from receipt of complete documents