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How to File a Claim
To File a Claim by Mail:
Mail your claim to the following address:
UniCare State Indemnity Plan
Andover Service Center
PO Box 9016
Andover, MA 01810-0916
To expedite the processing of your claim, it is important to include your group number
and enrollee ID number on every claim. You'll find this information on the front of your ID card . Each
claim must include the following information:
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diagnosis
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date of service
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amount charged
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name and address and type of provider
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provider tax ID number, if known
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enrollee's name
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enrollee's ID number
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patient's name
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description of each service or purchase
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information on any other group health insurance plan(s) under which you may be covered
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accident information, if applicable
- proof of payment, if applicable
View and print the Claim Form.
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