Need to file a medical claim? Read the following:
In most instances, Optima Health providers handle claims filing for members.
There are some instances when a member may need to file a medical claim. Examples include:
- Emergency or urgent care services received out of the service area
- Members with out-of-network benefits who receive routine services from non-participating providers
In instances where a member needs to file, Optima Health requires the following information:
- Member Name
- Member ID Number
- Treatment Sheets
- Itemized Bills containing Provider’s Tax ID Number, CPT Codes, and Diagnosis Codes
- Receipts of Payment
Note: Since most members will not have to file a claim, Optima Health does not have a specific claim form.
To file a claim, send the information noted above to:
Lason, Inc.
P.O. Box 5028
Troy, MI 48007-5028
Note: Optima Health has a timely filing limit for claim submission. Claims must be received within 365 from date of service.
Need to file a pharmacy claim? View our Pharmacy Reimbursement Instructions.
Need to file a claim for out-of-network vision benefits? Download Out-of-Network Vision Claim Form
If you have any questions, contact Member Services.