Providers (e.g., hospitals, skilled nursing
facilities, home health agencies, and physicians) and suppliers are
generally contracted to file claims for covered services and
supplies that you receive. You should not need to file claims.
Providers should be aware of any filing period limitations under
your plan in which claims must be filed for the services or
supplies provided (e.g., 180 days from date of service or purchase,
within one calendar year from date of service, etc). There are
times when members must submit a claim directly to their medical
FORMS: Members should contact member services (listed on the
insurance ID card) about which form or documentation is required
(e.g., HCFA1500 claim form, health benefit claim form, manufacturer
or supplier invoice, physician's order, etc)
HCFA1500: Members should complete as much information as they can.
Be sure to sign the appropriate boxes (see example). Members will
need to know the following:
1. HCPCS or Billing Code (ie. B4086, B9998, etc.)
2. ICD-9 or Diagnosis Code
Health Benefit Claim
Your particular medical plan may have specific forms for their
members to file. Contact member services listed on your insurance
card for more information.
INVOICE: Some medical plans only require the member to submit a
copy of their purchase receipt or the manufacturer or supplier
invoice. To ensure your claim is processed accurately and timely,
members should be sure to have the following information on the
1. Complete description of the medical supply
2. HCPCS or Billing Code (ie. B4086, B9998, etc.)
3. ICD-9 or Diagnosis Code (contact your physician)
CLAIM ADDRESS: Your insurance card should supply a claims address.
If not, contact member or customer service at the toll-free number
listed on the insurance card. Be sure to sign claim forms, if
applicable, and attach invoice or other documentation necessary for
your insurance to process your claim correctly.
IF THE CLAIM IS DENIED OR NOT REIMBURSED: As a member, you have the
right to request a review of the denied claim or file a grievance
in which you do not agree with how your claim was processed. To do
this, you must contact member services, listed on your insurance
card. You will need the following information:
1. Your Policy or Contract ID Number
2. Date of Service or Purchase Date supply was billed under
3. Amount or charge submitted on claim
4. Name of medical supplier
MIC-KEY Reimbursed Products
Contact the Kimberly-Clark Customer Service at 1-800-742-1996 to
find out to how purchase MIC-KEY enteral feeding tubes.
For more information on Medicare and Medicaid reimbursement, visit
the main Kimberly-Clark Health Care site Reimbursement page.