Health Care Providers

Submit a Paper Claim Electronically

Please complete the form fields on the next page and follow the instructions to upload your claim.

Complete Form

Check Eligibility & Benefits

Please complete the form fields on the next page and select your requested information from the Drop-Down Menu to request a benefits or claims status. A representative will provide your requested information.

Complete Form

Check The Status of a Claim

Please complete the form fields on the next page to request the status of a claim. A representative will provide your requested information.

Complete Form

Request a Pre-Determination of Benefits

Please complete the form fields on the next page and follow the instructions to upload documentation you wish to be considered.

Complete Form

Submit Documentation Requested By The Plan

Please complete the form fields on the next page and follow the instructions to upload your documentation.

Complete Form

Need more information?

To request additional information about any of the TPA services that we offer, please complete the short form below and a NEBA expert will contact you promptly.