How to File an Out-of-Network Claim:
- Complete all applicable fields on this form. Missing information may delay processing and reimbursement.
- Submit one claim form for each patient to CEC within 180 days of the date of service.
- Please upload a copy of your itemized receipt(s) for each service or product included on this claim form.
- This form must be electronically signed by the patient or his/her authorized representative.
IMPORTANT: Reimbursements are processed within a few weeks from the date we receive your electronic out-of-network claim form. For questions about your Member ID number or eligibility, please contact CEC at 888-254-4290.
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