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Claims Procedures

Medical Services

Submit completed claims for medical or other non-facility services on the CMS 1500 claim form. Standard CMS 1500 completion guidelines should be used in completing all applicable fields.

CMS 1500 Claim Form adobe pdf

Participating Hospitals or Ancillary Providers are required to submit a completed UB-04 or successor claim form in order to receive payment for Covered Services rendered.

CMS 1450 Claim Form adobe pdf

Dental Claims

Submit pretreatment estimates and claims for dental services using the ADA Claim form.

Dental Claim Form adobe pdf

Questions concerning the status of a claim should be directed to Member Services at (800) 811-3298.

Claims should be mailed to:

FirstCarolinaCare Insurance Company
P.O. Box 381686
Birmingham, Alabama 35238

If you are interested in transmitting claims electronically, please contact Provider Relations at (910) 715-8100 or toll-free at 1-800-574-8556.

 

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