Claims Submission

Welcome to the Claims Submission Page

• Electronic Claims Payor ID 56215
• Securely upload a Claim Document Securely upload a claim document
• Fax (336) 499-4006
• Mailing Address
  CBHA
  PO Box 571137
  Winston Salem, NC 27157-1137

  Member Claim Form

• Member Claim Information for Out-of-Network Providers
  • Out of Network Provider requirements:
    • Provider must be fully licensed
    • Your plan must have Out of Network Benefits
• Complete page one and either attach super bill from provider or ask the provider to fill out page two.
• Payments can either be sent directly to member or to provider depending on providers preference. Leave box 13 blank to receive payment.
• Call CBHA claims department at 1-800-475-7900 Monday-Friday from 8:30-5:00 pm for assistance in filling out form.