To view claims information for your patient, please login to your provider portal.
To submit a claim:
Please refer to the member’s ID card and specific plan benefits information for appropriate submission details for confirmation.
For all claims associated with Promise Health Plan with the Cigna Healthcare Shared Administration PPO Network as the Tier 2 network, send all medical claims to the following address or use the following Payer ID for electronic submission:
Cigna
PO Box 188061
Chattanooga, TN 37422-8061
Payer ID for Claims Submission: 62308
For all claims associated with Promise Health Plan with the First Health Complementary Network as the Tier 2 network, send all medical claims to the following address or use the following Payer ID for electronic submission:
Promise Health Plan
P. O. Box 4278
Clinton, IA 52733-4278
Payer ID for Claims Submission: RP128
Claims must be submitted within twelve (12) months of the date of service. Non-electronic claims may be submitted on any approved claim form, available from the provider. The claim must be completed in full, with all the requested information. A complete claim must include the following:
- Name of patient
- Patient’s date of birth
- Name of employee
- Address of employee
- Name of employer and group number
- Name, address and tax identification number of provider
- Employee Member Identification Number
- Date of service
- Diagnosis and diagnosis code
- Description of service and procedure number
- Charge for service
- The nature of the accident, injury or illness being treated.
- Sufficient documentation, in the sole determination of the Plan Administrator, to support the Medical Necessity of the treatment or service being provided to enable the Plan Supervisor to adjudicate the claim pursuant to the terms and conditions of the Plan.
CLAIMS WILL NOT BE DEEMED SUBMITTED UNTIL ALL REQUIRED INFORMATION IS RECEIVED.
Claims will be paid within 30 days from when all necessary information is received.