Mental Health and Chemical Dependency Benefits

Claims Submission Guidelines

Mental health and chemical dependency benefits are administered by OptumHealth Behavioral Solutions (Optum). Providers should electronically submit their claims to Optum. For direct submission, a HCFA 1500 claim form should be used. Download and print the HCFA 1500 Form (Adobe Acrobat reader is required, click here for free download). The claim form should include the following information:

Participant's Name
Participants Health Fund ID Number (as it appears on the Health Fund ID Card)
Provider's Name
Provider's Address
Provider's Federal Tax ID Number
Patient's Name
Patient's Date of Birth
Procedure Code (provided by doctor on bill)
Diagnosis Code (provided by doctor on bill)
Amount Paid (if any)

Claims should be submitted to the following address:

P.O. Box 31053
Laguna Hills, CA 92654-1053

To reach the Customer Service Unit, call (888) 301-0056.