How claims are processed and who processes them depends on the type of claim. Most claims are processed by the Administrative Office, except for those benefits, such as prescription drug, mental health and substance abuse, and dental benefits, that are administered by a third-party administrator. You'll find the contact information for the Fund's Claims Administrators in the Summary Of Benefits.

You may designate an authorized representative, such as your manager, to submit claims on your behalf. Call the Claims Administrator for details about what you need to do to designate a representative.

The Claims Administrator offers providers convenient electronic claims processing through a partnership with WebMD:

• If your provider is set up to submit claims electronically, give the provider the Fund's electronic claim submitter number: 23710.
• If your provider isn't familiar with the process, he/she can call the Fund at (818) 846-1015, extension 187, for further information about how to submit claims electronically.
• If your provider has any questions, have him/her contact the Provider Relations Department at 1-800-227-7863, extension 187, or WebMD at 1-877-GOWEBMD.

Filing Claims Yourself
If you prefer to file your own claim, or if you go to a non-network provider who will not submit a claim for you, you can pay your provider up-front, and then submit an itemized bill (evidence of loss) to the Administrative Office for reimbursement. The bill should include:

• Your name;
• Your ID number;
• Your provider's name, address and taxpayer ID number;
• Patient name;
• Patient date of birth;
• Procedure code;
• Diagnosis code; and
• Amount paid, if any.

Claim forms are not required. When you become eligible for medical benefits, your completed enrollment form is the only form the Administrative Office needs.

Submit medical claims no later than 90 days after your visit to a non-network physician. If a claim is filed late through no fault of yours, the Fund may consider paying it if it is submitted within two years of the date of service.

If your medical claim is the result of injuries suffered in an accident, submit details concerning the accident with the accident-related claim.

Claim Determinations
The Claims Administrator may deny or grant a claim, in whole or in part, at his/her discretion. The Fund's claims provisions will be applied consistently for claimants in similar circumstances who are similarly situated, as determined by the Claims Administrator. (See Section 6: Administrative Information for more information about claims and appeals.)