Geha address for claims

Feb 27, 2023 · How to submit a paper claim Please ensure you have GEHA’s current claims submission address. A delay in processing may occur if not sent to the below address. GEHA P.O. Box 21542 Eagan, MN 55121 Title documents re: action needed for claims submissions Please include a title describing the action needed for your claim submission(s) and documents.

Geha address for claims. Please Fill Out. Date of Illness/Injury (optional) Please enter the month, day and year of the patient's illness/injury. Once you submit this information, we will update your file. If it is more convenient, you may call us with this information at (800) 821-6136. Thank you for …

Claims should be submitted to: OptumHealth SM Behavioral Solutions. P O Box 30755. Salt Lake City UT 84130-0755. When Medicare is the primary payer, and will not cover your services, call the Plan at 703-729-4677 or 888-636-NALC (6252) to obtain benefits. Claims for Medicare-primary patients should be submitted to:

When you use your QuestSelect card at eligible locations, GEHA pays outpatient laboratory testing at 100%. With QuestSelect, you pay nothing — no deductible, no copay, no coinsurance. ^. Each non-Medicare Standard member* will receive a QuestSelect card following enrollment in the medical plan. However, QuestSelect is an optional program. Wednesday, Apr 3, 2024. Cyber security and IT concept for health information (Getty Images). Federal employees, retirees and dependants covered by GEHA health care are …GEHA Resources. Starting January 1, 2024, authorizations for GEHA Lab procedures will be required from United Healthcare Choice Network and no longer through EviCore. For dates of service on or after January 1, 2024, please contact United Healthcare Choice at (877)585-9643, who will begin accepting 2024 authorization on December 1, 2023.DeltaCare ® USA Claims Mailing addresses for your DeltaCare USA claims. DeltaCare USA P.O. Box 1810 Alpharetta, GA 30023 AARP Dental Insurance Plan Claims. Mailing addresses for your AARP Dental Insurance Plan claims. AARP Dental Insurance Plan c/o Delta Dental Insurance Company P.O. Box 2059 Mechanicsburg, PA 17055-2059 Other …To address this, our teams have implemented a phased, and measured, rollout to resume normal operations. We thank you for your patience while this process was tested. ... GEHA is working through claims in a chronological order beginning from the last day of claims processing when the CHC cybersecurity issue took place on Feb. 21, 2024. We are ...Whether you obtained a copy of iOS 5 as a developer or through less-official channels, you can get a free me.com email address right now. Here's how. Whether you obtained a copy of...Other Ways to Contact Us. Members 877.277.6872. Dental providers 800.505.8880. Business Development 877.477.6872. Email [email protected]

Address for Part B Claim Forms (medical, influenza/pneumococcal vaccines, lab/imaging) and foreign travel. Noridian Healthcare Solutions, LLC. P.O. Box 6703. Fargo, ND 58108-6703. Address for priority mail/commercial couriers (Part B) –. Address for durable medical equipment, prosthetics, orthotics and supplies.To address this, our teams have implemented a phased, and measured, rollout to resume normal operations. We thank you for your patience while this process was tested. ... GEHA is working through claims in a chronological order beginning from the last day of claims processing when the CHC cybersecurity issue took place on Feb. 21, 2024. We are ...Yes. As of January 15, 2022, GEHA covers COVID-19 OTC test kits through its pharmacy benefit. Members may visit a participating retail network pharmacy (subject to availability and participation) to obtain certain OTC COVID-19 test kits at $0.00 cost using their prescription benefit card.Average salary for Geha Claims Adjuster in Kansas City: $30. Based on 200 salaries posted anonymously by Geha Claims Adjuster employees in Kansas City.If you are looking for claim, provider or plan information, sign in to your GEHA web account and click the My Vision Account button or contact EyeMed Member Services at 877.808.8538. You will need to pay for out-of-network services in full at the time of service, and submit an out-of-network claim form (PDF) along with a copy of the itemized ...

A GEHA is a self-insured and not-for-profit association providing health insurance benefit plans to federal employees, retirees and their dependents. ... A Submit paper claims to the address on the back of the member ID card. Submit electronic claims online at www.uhis.com, Emdeon ® payer ID 39026.Dental Appeal Form. If you would like GEHA to reconsider its initial decision on your dental benefit claim, please complete this appeal form. You must write to us within 6 months of the date of our decision. GEHA is the second-largest national health plan and the second-largest national dental plan serving federal employees, federal retirees ...GEHA offers five unique medical plan options, each with comprehensive coverage that coordinates with Medicare. When you have GEHA and Medicare, most of your claims can be filed electronically by GEHA Express. For information on electronic claims filing, call GEHA Express at 800.282.4342. Enroll now.You will need to pay for out-of-network services in full at the time of service, and submit an out-of-network claim form (PDF) along with a copy of the itemized bill for reimbursement and the primary coverage EOB to the following address: EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111Federal regulations require that a claim submitted by a provider must be filed on a CMS-1500 form. If you need to submit a medical claim yourself and you have an itemized bill, please attach and mail to PO Box 21542, Eagan, MN 55121. If you need assistance with completing this form, please contact GEHA at (800) 821-6136.

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Submit claims to the network address on the back your GEHA ID card, for both in- and out-of-network claims. Submit Medicare primary claims or out-of-network charges that you have paid in full to: GEHA P.O. Box 21542 Eagan, MN 55121 Note: All claims submitted to GEHA should include itemized bills that show the following information:All medical claims should be mailed to the addresses listed below for each network. All dental claims should be mailed to GEHA at the appropriate address below: Dental Claims: GEHA FEHB Medical. P.O. Box 21542. Eagan, MN 55121. GEHA FEHB Dental. P.O. Box 21542. Eagan, MN 55121.GEHA offers discounts on prescriptions to help you save on your medical costs where you can. Depending on the medication, you will pay a set amount as a copay or a percentage of the cost. Generic drugs typically cost less than brand-name medications. Another savings option includes a lesser copay amount by getting a 90-day supply through CVS ...GEHA has a dedicated email address for our members outside the United States, [email protected]. Filing International Claims. For services you receive outside of the United States, send a completed Dental Claim Form and the itemized bills to GEHA, Foreign Dental Claims Department, P. O. Box 21542, Eagan, MN 55121-9930.

GEHA has a dedicated email address for our members outside the United States, [email protected]. Filing International Claims. For services you receive outside of the United States, send a completed Dental Claim Form and the itemized bills to GEHA, Foreign Dental Claims Department, P. O. Box 21542, Eagan, MN 55121-9930.About Geha Health Plan For Federal Employees. Geha Health Plan For Federal Employees is located at Po Box 4665 in Independence, Missouri 64051. Geha Health Plan For Federal Employees can be contacted via phone at for pricing, hours and directions.How to submit a paper claim Please ensure you have GEHA’s current claims submission address. A delay in processing may occur if not sent to the below address. GEHA P.O. …Representative complete address: Representative phone number: I hereby appoint my Representative as follows: (NOTE: One box below MUST be checked for this form to be ... GEHA Claims Department . P.O. Box 21542 Eagan, MN 55121 . AR0219 _____ FE-FRM-1223-002 508. Title: GEHA Authorized Representative Designation For Claims Form ...When you use your QuestSelect card at eligible locations, GEHA pays outpatient laboratory testing at 100%. With QuestSelect, you pay nothing — no deductible, no copay, no coinsurance. ^. Each non-Medicare Standard member* will receive a QuestSelect card following enrollment in the medical plan. However, QuestSelect is an optional program.After the preauthorization review is complete, you will receive a letter in the mail. Your provider will receive a fax and letter via mail detailing the determination. If you have not received your determination letter, GEHA recommends working with your provider. You may contact GEHA at 800.821.6136.Find Care provider search. To direct you to the right list of in-network providers, please select a plan from below. Medical Plans. Elevate. High Deductible Health Plan (HDHP) Standard Option. Elevate Plus. High Option. Dental Plans.Prescription Reimbursement Claim Form. Always allow up to 30 days from the time you receive the response to allow for claims processing and delivery. Keep a copy of all documents submitted for your records. Do not staple receipts or attachments to this form. Reimbursement is not guaranteed and other contractor will review the claims subject to ...DeltaCare ® USA Claims Mailing addresses for your DeltaCare USA claims. DeltaCare USA P.O. Box 1810 Alpharetta, GA 30023 AARP Dental Insurance Plan Claims. Mailing addresses for your AARP Dental Insurance Plan claims. AARP Dental Insurance Plan c/o Delta Dental Insurance Company P.O. Box 2059 Mechanicsburg, PA 17055-2059 Other …P.O. Box 30783 Salt Lake City, UT 84130-0783. If you have already paid your out-of-network bill in full, mail your claim form to: GEHA. P.O. Box 21542 Eagan, MN 55121. What happens next. After processing your claim, you’ll receive an Explanation of Benefits (EOB). The EOB explains the charges applied to your deductible (the amount you pay for ...

To refill a prescription, follow the steps below: Phone: Call Member Services at 844.4.GEHA.RX or 844.443.4279. Have your prescription bottle with the prescription information ready. Mail: Simply mail the GEHA Mail Service Order Form and copayment to CVS Caremark, PO Box 659541, San Antonio, TX 78265-9541. Online: Visit caremark.com.

When you make a claims inquiry, you will see a list of health and dental claims processed by GEHA. Click on an individual claim to view the online version of a GEHA explanation of benefits form (EOB). The claim detail will include the date of service along with dollar amounts for charges and benefits. Submit Documents Providers can submit a ...GEHA offers discounts on prescriptions to help you save on your medical costs where you can. Depending on the medication, you will pay a set amount as a copay or a percentage of the cost. Generic drugs typically cost less than brand-name medications. Another savings option includes a lesser copay amount by getting a 90-day supply through CVS ...We would like to show you a description here but the site won’t allow us.Claims UnitedHealthcare Community Plan Quest Integration P.O. Box 31365 – mailing address Salt Lake City, UT 84131-0365 Payer ID#: 87726 (EDI Claims Submission) Claims Optum P.O. Box 30757 – mailing address Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Medicare Advantage and Community …You can make post-tax contributions directly into your HSA and claim them as a tax deduction. Total 2024 HSA contributions, including GEHA’s contributions to your HSA, cannot exceed: 1. $4,150 for Self Only, $8,300 for Self Plus One or Self and Family; Plus $1,000 in "catch up" contributions for individuals age 55+Search PHCS GEHA PayerID 45275 and find the complete info about PHCS GEHA Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more ... Real Time Claim Status (RTS): NO. Electronic Remittance Advice (835) [ERA]: NO. ... Request Payer Contact Address to Send Claims by PostOur Customer Care call center is open from 7 a.m. to 7 p.m. Central Time, Monday through Friday, excluding holidays. GEHA Connection Dental Federal members outside the United States can call us using a dedicated phone number. In addition, GEHA will accept collect calls from our members overseas. Then enter our GEHA toll-free number: 877.320.9469.Check the member’s ID card for contact information. For eligibility, summary of benefits, prior authorization requirements and claim status, call Provider Services at 877-343-1887 or visit uhss.umr.com open_in_new. *This change does not impact GEHA members on policy 918695, Surest policy 78800521 or Medicare Advantage (PPO) Group Numbers ...When you use your QuestSelect card at eligible locations, GEHA pays outpatient laboratory testing at 100%. With QuestSelect, you pay nothing — no deductible, no copay, no coinsurance. ^. Each non-Medicare Standard member* will receive a QuestSelect card following enrollment in the medical plan. However, QuestSelect is an optional program.

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2023 Elevate Plus and Elevate Options Medical Plan Brochure. This brochure (RI 71-018) describes the benefits, exclusions, limitations and maximums of the Elevate and Elevate Plus medical plans for 2023. PDF.I, the undersigned, authorize and request GEHA to make payment for benefits due herein to: Name of Provider: Signature of Subscriber/Patient: Date: GEHA. Foreign Claims Department P.O. Box 21542 • Eagan, MN 55121 • Telephone: 800.821.6136 • Email: [email protected] • Website: geha.com. FE-FRM-0223-001 508.GEHA's Standard and High medical plans offer no-to-low deductibles and copays for Medicare enrollees plus comprehensive prescription coverage. Our High plan even provides a Medicare Part B Reimbursement Account of $1,000 in 2024 to help cover premiums. New for 2024! Two new GEHA Medicare Advantage Plans. See what additional benefits and ...After the preauthorization review is complete, you will receive a letter in the mail. Your provider will receive a fax and letter via mail detailing the determination. If you have not received your determination letter, GEHA recommends working with your provider. You may contact GEHA at 800.821.6136.Find Care provider search. To direct you to the right list of in-network providers, please select a plan from below. Medical Plans. Elevate. High Deductible Health Plan (HDHP) Standard Option. Elevate Plus. High Option. Dental Plans.Representative complete address: Representative phone number: I hereby appoint my Representative as follows: (NOTE: One box below MUST be checked for this form to be ... GEHA Claims Department . P.O. Box 21542 Eagan, MN 55121 . AR0219 _____ FE-FRM-1223-002 508. Title: GEHA Authorized Representative Designation For Claims Form ...Find Care provider search. To direct you to the right list of in-network providers, please select a plan from below. Medical Plans. Elevate. High Deductible Health Plan (HDHP) Standard Option. Elevate Plus. High Option. Dental Plans. Videos on benefit information and wellness tips. Whether you're shopping for a GEHA medical or dental plan, or you're already a member, or you're a provider looking for resources, our Resource Center is the best place to find what you're looking for, including benefits guides, plan brochures, forms, videos — and much more. To address this, our teams have implemented a phased, and measured, rollout to resume normal operations. We thank you for your patience while this process was tested. ... GEHA is working through claims in a chronological order beginning from the last day of claims processing when the CHC cybersecurity issue took place on Feb. 21, 2024. We are ...Health care provider claim submission tools and resources. Learn how to submit a claim, submit reconsiderations, manage payments, and search remittances. Health care professionals working with UnitedHealthcare can use our digital tools to access claims, billing and payment information, forms and get live help.There isn’t anyone who’s happy about the idea of being in a situation where an insurance claim needs filling. However, if this is your case, making mistakes could be costly. Theref... ….

Federal employees, retirees and dependants covered by GEHA health care are still experiencing service outages as the company is working to restore claims processing and repayment systems after a ...If you have not paid your out-of-network bill in full, mail your claim form to: UnitedHealthcare Shared Services PO Box 30783 Salt Lake City, UT 84130-0783 If you have already paid your out-of-network bill in full, mail your claim form to: GEHA. P.O. Box 21542 Eagan, MN 55121. What happens next. After processing your claim, you’ll receive an ...I, the undersigned, authorize and request GEHA to make payment for benefits due herein to: Name of Provider: Signature of Subscriber/Patient: Date: GEHA. Foreign Claims Department P.O. Box 21542 • Eagan, MN 55121 • Telephone: 800.821.6136 • Email: [email protected] • Website: geha.com. FE-FRM-0223-001 508.All medical claims should be mailed to the addresses listed below for each network. All dental claims should be mailed to GEHA at the appropriate address below: Dental Claims: GEHA FEHB Medical. P.O. Box 21542. Eagan, MN 55121. GEHA FEHB Dental. P.O. Box 21542. Eagan, MN 55121.Authorized Representative Designation for Claims Form. This form is for enrollees and dependents covered by the GEHA health and/or Connection Dental Plus plans who want to designate an Authorized Representative.In addition, when our providers complete directory updates in a timely manner and submit address change forms, this helps payors identify the correct claim payment mailing address. For more information about directory updates, please contact us at 1.800.505.8880 or visit our website at connectiondental.com. .New in 2024: Nitrous oxide will now be covered for all ages for covered procedures, if medically necessary. New in 2024: Coverage for prefabricated porcelain/ceramic crowns on primary teeth, limited to one per patient, per tooth, per lifetime. Vision benefit: $5 routine eye exam plus frames, contact lens and Lasik discounts*.I, the undersigned, authorize and request GEHA to make payment for benefits due herein to: Name of Provider: Signature of Subscriber/Patient: Date: GEHA. Foreign Claims Department P.O. Box 21542 • Eagan, MN 55121 • Telephone: 800.821.6136 • Email: [email protected] • Website: geha.com. FE-FRM-0223-001 508.210-531-USAA (8722) 800-531-USAA (8722) Shortcut Mobile Number. #USAA (8722) Works with most carriers. USAA Main Mailing Address. USAA. 9800 Fredericksburg Rd. … Federal regulations require that a claim submitted by a provider must be filed on a CMS-1500 form. If you need to submit a medical claim yourself and you have an itemized bill, please attach and mail to PO Box 21542, Eagan, MN 55121. If you need assistance with completing this form, please contact GEHA at (800) 821-6136. Geha address for claims, Community Plan Claims & medical records P.O. Box 5290 Kingston, NY 12402-5290. Community Plan Behavioral health P.O. Box 30760 Salt Lake City, UT 84130-0760. ACC/DD/Dual Complete 800-445-1638. Dual Complete® (HMO D-SNP) Attn: Provider claim disputes P.O. Box 31364 Salt Lake City, UT 84131-0364. General claim disputes …, Information about claims that are not listed on the GEHA website may be obtained by calling GEHA’s Customer Service Department at (800) 821-6136. ... All claims should be submitted to the address on the back of the members’ identification cards. Please keep in mind that approximately 90 companies use the Connection Dental Network to offer a ..., I, the undersigned, authorize and request GEHA to make payment for benefits due herein to: Name of Provider: Signature of Subscriber/Patient: Date: GEHA. Foreign Claims Department P.O. Box 21542 • Eagan, MN 55121 • Telephone: 800.821.6136 • Email: [email protected] • Website: geha.com. FE-FRM-0223-001 508., Search PHCS GEHA PayerID 45275 and find the complete info about PHCS GEHA Insurance Type, LOB, ENR, RTE, RTS, ERA, SEC, Customer Service Number and more ... Real Time Claim Status (RTS): NO. Electronic Remittance Advice (835) [ERA]: NO. ... Request Payer Contact Address to Send Claims by Post, UnitedHealthcare Shared Services is a service model that gives plan sponsors access to the UnitedHealthcare network but allows them to self-administer plan benefits or have a third-party administrator (TPA) administer benefits on their behalf. This means you can treat members with UnitedHealthcare Shared Services because they have access to …, When you use your QuestSelect card at eligible locations, GEHA pays outpatient laboratory testing at 100%. With QuestSelect, you pay nothing — no deductible, no copay, no coinsurance. ^. Each non-Medicare Standard member* will receive a QuestSelect card following enrollment in the medical plan. However, QuestSelect is an optional program. , Jan 1, 2024 · claims information for GEHA members. • Federal Employee Health Benefits program (FEHB Medical plans) utilizes the GEHA Connection Dental Network. • GEHA Dental plans utilize four networks: GEHA Connection Dental Network, CIGNA Network, Careington Network and DentaMax Network. • GEHA Connection Dental Contact Number: 800.505.8880 , Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111. Please allow at least 14 calendar days to process your claims once received by EyeMed. Your claim will be processed in the order it is received. A check and/or explanation of benefits will be mailed within seven (7) calendar days of the date your claim is processed., A mining claim gives a claimant the right to remove mineral deposits that are discovered on a parcel of land. With a patented mining claim, public land becomes private land when th..., MEDICAL APPEAL FORM. If you would like GEHA to reconsider our initial decision on your benefit claim, please complete this appeal form. You must write to us within 6 months of the date of our decision. You can mail, fax or email your request to GEHA: Mail your request to GEHA, PO Box 21542, Eagan, MN 55121; Fax your request to the Appeals ..., Prescription Reimbursement Claim Form. Always allow up to 30 days from the time you receive the response to allow for claims processing and delivery. Keep a copy of all documents submitted for your records. Do not staple receipts or attachments to this form. Reimbursement is not guaranteed and other contractor will review the claims subject to ..., I, the undersigned, authorize and request GEHA to make payment for benefits due herein to: Name of Provider: Signature of Subscriber/Patient: Date: GEHA. Foreign Claims Department P.O. Box 21542 • Eagan, MN 55121 • Telephone: 800.821.6136 • Email: [email protected] • Website: geha.com. FE-FRM-0223-001 508., • Reimbursement is not guaranteed. Claims are subject to limitations, exclusions and provisons of the plan. • Do not use this claim form to request reimbursement for other prescription drug claims. STEP 1 Card Holder/Patient Information This section must be fully completed to ensure proper reimbursement of your claim. Card Holder Information, Dental/ADA Claims. Eligibility / Benefits. Due to an event at the payers EDI vendor, the payer is currently unable to process eligibility. Yes. Electronic Attachments. Secondary Claims. Yes. This payer is also known as: Government Employees Hospital Association Government Employees Hospital Association GEHA Government Employees Health ..., Elect a GEHA Medicare Advantage Plan today. If you already enrolled in the GEHA High or Standard plan with Medicare Parts A and B call UnitedHealthcare to elect the GEHA Medicare Advantage Plan at 844.491.9898, TTY 711, …, Claims UnitedHealthcare Community Plan Quest Integration P.O. Box 31365 – mailing address Salt Lake City, UT 84131-0365 Payer ID#: 87726 (EDI Claims Submission) Claims Optum P.O. Box 30757 – mailing address Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Medicare Advantage and Community …, Contact GEHA GEHA members outside the United States can call us using a dedicated phone number. In addition, GEHA will accept collect calls from our members overseas. When calling from outside the United States: Call the AT&T USADirect access number for the country from which you're calling. Then, enter our GEHA toll-free number: 877.320.9469. , The address for our administrative office is: GEHA Connection Dental Federal 310 NE Mulberry St Lee's Summit, MO 64086 (877) GEHA-DEN or (877) 434-2336 www.geha.com ... GEHA Connection Dental Federal complies with all applicable Federal civil rights laws, to include both Title VII of the Civil ... International Claims Payment ..., Sign and date the reimbursement form. GEHA cannot process without a valid signature. Copy form and all documentation. Keep copies attached documentation copies to GEHA. of form and all documentation for your records. Mail the original form and. DO NOT staple. Please tape receipts to an 81⁄2 x 11 blank sheet of paper., UnitedHealthcare Shared Services. P.O. Box 30783. Salt Lake City, UT 84130-0783. If you have already paid your out-of-network bill in full, mail your claim form to the address below. In addition, submit your dental, Medicare prime and all other claims (such as Medicaid and prescription claims) to GEHA at: GEHA. P.O. Box 21542., The clinical guidelines are intended to inform network providers and GEHA medical plan members of the medical plan's position on the treatment of certain common conditions. These guidelines apply to HDHP, Standard and High medical plan members. GEHA's Provider resources includes authorization forms, clinical guidelines and coverage policies., There is no address for all Medicare claims across the country. Instead, each state works with a Medicare Administrative Contractor (MAC) that handles the claims. Original …, Mailing Address: Connection Dental Network PO Box 6707 Lee's Summit, MO 64064. Click on your state on the map to find the Network Development Staff member or Provider Relations Specialist responsible for your area. You can reach your designated staff member by phone, Monday through Friday, 8 a.m. to 4:30 p.m. Central Standard Time., We would like to show you a description here but the site won’t allow us., Other Ways to Contact Us. Members 877.277.6872. Dental providers 800.505.8880. Business Development 877.477.6872. Email [email protected], If you find the claim needs to be submitted and mailed to GEHA by you, please complete a Medical Claim Form. When you’re ready to mail your out-of-network medical claim to GEHA, send it to the following address: PO Box 21542 Eagan, MN 55121. If you are filing an out-of-network claim yourself, visit filing an out-of-network medical claim with ..., Send claims to the correct payer. Send claims to the payer. You’ll find the payer ID (for electronic claims) and address (for paper claims) on the member’s ID card. If a member uses a transplant facility in our Institutes of Excellence™ network, the facility will use the Special Case Customer Service Unit for submitting claims., We would like to show you a description here but the site won’t allow us., Out-of-network deductible for Class B and C services is $25 Standard Self Only, $50 Standard Self Plus One and $75 Standard Self and Family.. 1 If your out-of-network dentist charges more than GEHA's agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network …, Independent claims adjusters are often referred to as independent because they are not employed directly by an agency, reveals Investopedia. Instead, they work as a third-party who..., GEHA Medicare Advantage enrollees are not eligible to earn GEHA Health Rewards. Q: Who do I contact with questions? A: Contact UMR for Health Rewards program or Well-being portal related questions at 800.860.6933. Contact HealthEquity for questions related to your Health Rewards debit card or account balance at 844.768.5644., Authorized Representative Designation for Claims Form. This form is for enrollees and dependents covered by the GEHA health and/or Connection Dental Plus plans who want to designate an Authorized Representative., Community Plan Claims & medical records P.O. Box 5290 Kingston, NY 12402-5290. Community Plan Behavioral health P.O. Box 30760 Salt Lake City, UT 84130-0760. ACC/DD/Dual Complete 800-445-1638. Dual Complete® (HMO D-SNP) Attn: Provider claim disputes P.O. Box 31364 Salt Lake City, UT 84131-0364. General claim disputes …