You may use your own standard claim form.
Claims for covered services should be submitted within 30 days of the date of service, and no later than 60 days following the date of service. Claims not submitted within this filing period will not be honored for payment. Reconsideration, resubmission or any follow-up must be identified clearly and submitted within one year from the date of service.
If you have questions on where to send your claim, please refer to your provider manual or call 1-877-393-6094.