Which Form Do I Need?

Please use the following forms thusly: a. Individual Claim Form: To be completed when a Member visits a non-MedeCus Provider, pays upfront and needs to claim back to MedeCus for reimbursement. Forms must be submitted to MedeCus within 30 days from the date of service. b. Dental Claim Form: To be completed by MedeCus’ Dental Providers when online claim submission is not possible. Forms must be submitted to MedeCus within 30 days from the date of service. c. Optical Claim Form: To be completed by MedeCus’ Members or Optical Providers when online claim submission is not possible. Providers must submit this form to MedeCus within 30 days from the date of service, while Members have 90 days to do so. d. Claim Form for Participating Doctors and Diagnostics: To be completed by non-Dental and/or non-Pharmacy Providers when online claim submission is not possible. Forms must be submitted to MedeCus within 30 days from the date of service. e. Pharmacy Prescription Drug Claim Form: To be completed by Pharmacy Providers when online claim submission is not possible. Forms must be submitted to MedeCus within 30 days from the date of service.