DOCUMENTS NEEDED TO PROCESS A CLAIM
- Bill/Health Insurance Claim Form a/k/a “HICFA”
- Run notes/Trip notes from provider
- Explanation of Benefits a/k/a “EOB”
NEW CLAIM INSTRUCTIONS
- Submit the bill from the ambulance company to MASA with Member’s MASA number clearly displayed.
- Submit the bill via E-Mail, Fax or Mail.
- Attach the EOB and run notes, if readily available.
- Contact the claims department directly with any questions.
ATTN: CLAIMS DEPT.
1250 S. Pine Island Road, Suite 500
Plantation, FL 33324