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filings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. ALLIED BENEFIT SYSTEMS Allied is a national healthcare solutions company that supports healthy workplace. cultures. As problem-solvers, innovators and collaborators, our team pairs. innovative solutions and data analytics that inspire creative solutions. In collaboration with clients and benefits consultants, we. LOGIN | ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claimfilings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination.COVID-19 UPDATE
On March 18, 2020, the Federal Government put into law the Families First Coronavirus Response Act, effective immediately. This law requires all group health plans waive COVID-19 testing costs, including copays, deductibles and coinsurance costs, without prior authorization for the following: Health care provider visits, urgentcare visits, and
FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
HEALTH, WELLNESS & COST-MANAGEMENT SOLUTIONS Allied's nationally recognized proprietary claim management strategy assists employers in controlling spiraling healthcare costs. Allied Advocate is designed to provide personalized assistance to members as they navigate the healthcare system while creating health plan transparency and aggressively managing high-dollar healthcareexpenses.
CUSTOM SELF-FUNDED GROUP HEALTH INSURANCE PLANS Executive Vice President. rvalerious@alliedbenefit.com. For more information on the National General Benefits Solutions Self-Funded Program administered by Allied contact: National General Benefits Solutions. Self-Funded Team. 888.292.0272. ngbs.selffunded@alliedbenefit.com. CURRENT CAREER OPPORTUNITIES AT ALLIED BENEFIT SYSTEMS Quality. Innovation. At Allied, we're a team of caring, helpful, and loyal leaders and contributors. As an outstanding healthcare solutions company, our objective is to take care of employees and their families each and every day — and it all starts with the Allied family. Our diverse leadership team supports an inclusive culture focused onFORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. PROVIDER ELIGIBILITY/CLAIM INQUIRY Enter the required information below to view patient eligibility status or claim status. The information you enter must match the information that appears on the patient's ID card and the submittedclaim form.
MEDICAL CLAIM FORM
For claim mailing address, please refer to the back of the Employee's ID card. Contact Allied at (800) 288-2078 Employer Information Employee Information SPECIALTY PHARMACY MEDICAL REQUEST Specialty Pharmacy Medical Request Allied Benefit Systems P 800.288.2078 PO Box 909786-60690 F Chicago, IL 60690-9786 Address City State Zip Home Phone Work Phone Cell PhoneFAX COVER SHEET
Fax Cover Sheet Allied Benefit Systems P 800.288.2078 PO Box 909786-60690 F Chicago, IL 60690-9786 E webinfo@alliedbenefit.com Sender's Name Sender's Phone Number Today's Date Documents Included: ALLIED BENEFIT SYSTEMS Allied is a national healthcare solutions company that supports healthy workplace. cultures. As problem-solvers, innovators and collaborators, our team pairs. innovative solutions and data analytics that inspire creative solutions. In collaboration with clients and benefits consultants, we. LOGIN | ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claimfilings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card.FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
ALLIED BENEFIT SYSTEMS Allied is a national healthcare solutions company that supports healthy workplace. cultures. As problem-solvers, innovators and collaborators, our team pairs. innovative solutions and data analytics that inspire creative solutions. In collaboration with clients and benefits consultants, we. LOGIN | ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claimfilings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card.FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
COVID-19 UPDATE
On March 18, 2020, the Federal Government put into law the Families First Coronavirus Response Act, effective immediately. This law requires all group health plans waive COVID-19 testing costs, including copays, deductibles and coinsurance costs, without prior authorization for the following: Health care provider visits, urgentcare visits, and
FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
HEALTH, WELLNESS & COST-MANAGEMENT SOLUTIONS Allied's nationally recognized proprietary claim management strategy assists employers in controlling spiraling healthcare costs. Allied Advocate is designed to provide personalized assistance to members as they navigate the healthcare system while creating health plan transparency and aggressively managing high-dollar healthcareexpenses.
PROVIDER FORMS
Provider Forms. Claim Form - Medical. Claim Form - Dental. Claim Form - Vision. Formulary Drug Removals. Formulary Exclusion Prior Authorization Form. HIPAA Authorization Form. Retail Pharmacy Prior Authorization Request Form. Specialty Pharmacy Request Form. CUSTOM SELF-FUNDED GROUP HEALTH INSURANCE PLANS Executive Vice President. rvalerious@alliedbenefit.com. For more information on the National General Benefits Solutions Self-Funded Program administered by Allied contact: National General Benefits Solutions. Self-Funded Team. 888.292.0272. ngbs.selffunded@alliedbenefit.com. PROVIDER ELIGIBILITY/CLAIM INQUIRY Enter the required information below to view patient eligibility status or claim status. The information you enter must match the information that appears on the patient's ID card and the submittedclaim form.
MEDICAL CLAIM FORM
For claim mailing address, please refer to the back of the Employee's ID card. Contact Allied at (800) 288-2078 Employer Information Employee InformationFACILITY IMS, LLC
2 FACILITY IMS, LLC 5420 West Plano Parkway Plano, TX 75093 Phone: (972) 931-3800 Fax: (972) 931-3801 BASIC PLAN This booklet describes the Medical benefits for Eligible Employees of Facility IMS, LLC SPECIALTY PHARMACY MEDICAL REQUEST Specialty Pharmacy Medical Request Allied Benefit Systems P 800.288.2078 PO Box 909786-60690 F Chicago, IL 60690-9786 Address City State Zip Home Phone Work Phone Cell PhoneFAX COVER SHEET
Fax Cover Sheet Allied Benefit Systems P 800.288.2078 PO Box 909786-60690 F Chicago, IL 60690-9786 E webinfo@alliedbenefit.com Sender's Name Sender's Phone Number Today's Date Documents Included: ALLIED BENEFIT SYSTEMS Allied is a national healthcare solutions company that supports healthy workplace. cultures. As problem-solvers, innovators and collaborators, our team pairs. innovative solutions and data analytics that inspire creative solutions. In collaboration with clients and benefits consultants, we. LOGIN | ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claimfilings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
MEDICAL CLAIM FORM
For claim mailing address, please refer to the back of the Employee's ID card. Contact Allied at (800) 288-2078 Employer Information Employee Information ALLIED BENEFIT SYSTEMS Allied is a national healthcare solutions company that supports healthy workplace. cultures. As problem-solvers, innovators and collaborators, our team pairs. innovative solutions and data analytics that inspire creative solutions. In collaboration with clients and benefits consultants, we. LOGIN | ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claimfilings/appeals.
LOGIN PAGE - ALLIED BENEFIT SYSTEMS New guidance from the Federal Government as to extended deadlines for 1) COBRA, 2) special enrollment, and 3) healthcare claim filings/appeals. Click here to learn more. To login, enter your account number and password and click on the Press to Login button. Please read the Allied website disclaimer and user policy. Unauthorized user access is ALLIED ADMINISTRATIVE SERVICES FOR HEALTHCARE PROVIDERS Physicians, hospitals, clinics and additional providers access vital information related to member eligibility and claims status via AlliedBenefit.com. Healthcare providers can submit claims directly through the Emdeon-Change Healthcare clearinghouse and leverage Allied’s electronic claims processing software to reduce claim payment turnaround time. EXTENDED PLAN DEADLINES An employee incurs a claim on April 1, 2020. Absent the deadline extension, the claim must be submitted by April 1, 2021. However, under the Guidance, the claim must be submitted by the earlier of (1) April 1, 2022, or (2) 365 days after the end of the Outbreak Period. External Review Process. CONTACT ALLIED BENEFIT SYSTEMS Visit Allied’s Provider FastTrack for access to member Eligibility, Claim Status, and more. To speak with a representative, please contact Allied’s Customer Service team by calling the number on the back of the member’s ID card. HEALTHCARE PROVIDER FASTTRACK Provider FastTrack Eligibility and Claims Status Inquiry. Use our secure web-based Provider FastTrack system for immediate access to member claims and eligibility status. Enter the required information to view a member eligibility status or claims status. The information you enter must match the information that appears on the member's IDcard
FORM INSTRUCTIONS
Please complete and return via FAX or E‐mail Call/Fax: Tel: 888‐292‐0272 FAX: 312‐416‐2860 E‐mail: NGBS.MemberTermination@alliedbenefit.com FORM INSTRUCTIONS Please complete the form and submit to Allied within 30 days of a member coverage termination. JANUARY 2021 FORMULARY DRUG REMOVALS January 2021 Updated 11/01/2020 Formulary Drug Removals Below is a list of medicines by drug class that have been removed from yourplan’s formulary.
MEDICAL CLAIM FORM
For claim mailing address, please refer to the back of the Employee's ID card. Contact Allied at (800) 288-2078 Employer Information Employee InformationCOVID-19 UPDATE
On March 18, 2020, the Federal Government put into law the Families First Coronavirus Response Act, effective immediately. This law requires all group health plans waive COVID-19 testing costs, including copays, deductibles and coinsurance costs, without prior authorization for the following: Health care provider visits, urgentcare visits, and
FORMS AND DOCUMENTS
Resources. Take control of your own healthcare with access to our comprehensive toolkit of forms and resources. With the right information, you can make more responsible, financial healthcaredecisions.
HEALTH, WELLNESS & COST-MANAGEMENT SOLUTIONS Allied's nationally recognized proprietary claim management strategy assists employers in controlling spiraling healthcare costs. Allied Advocate is designed to provide personalized assistance to members as they navigate the healthcare system while creating health plan transparency and aggressively managing high-dollar healthcareexpenses.
CUSTOM SELF-FUNDED GROUP HEALTH INSURANCE PLANS Executive Vice President. rvalerious@alliedbenefit.com. For more information on the National General Benefits Solutions Self-Funded Program administered by Allied contact: National General Benefits Solutions. Self-Funded Team. 888.292.0272. ngbs.selffunded@alliedbenefit.com. CURRENT CAREER OPPORTUNITIES AT ALLIED BENEFIT SYSTEMS Quality. Innovation. At Allied, we're a team of caring, helpful, and loyal leaders and contributors. As an outstanding healthcare solutions company, our objective is to take care of employees and their families each and every day — and it all starts with the Allied family. Our diverse leadership team supports an inclusive culture focused on PROVIDER ELIGIBILITY/CLAIM INQUIRY Enter the required information below to view patient eligibility status or claim status. The information you enter must match the information that appears on the patient's ID card and the submittedclaim form.
MEDICAL CLAIM FORM
For claim mailing address, please refer to the back of the Employee's ID card. Contact Allied at (800) 288-2078 Employer Information Employee InformationFACILITY IMS, LLC
2 FACILITY IMS, LLC 5420 West Plano Parkway Plano, TX 75093 Phone: (972) 931-3800 Fax: (972) 931-3801 BASIC PLAN This booklet describes the Medical benefits for Eligible Employees of Facility IMS, LLC SPECIALTY PHARMACY MEDICAL REQUEST Specialty Pharmacy Medical Request Allied Benefit Systems P 800.288.2078 PO Box 909786-60690 F Chicago, IL 60690-9786 Address City State Zip Home Phone Work Phone Cell Phone SPECIALTY PHARMACY MEDICATION REQUEST Specialty Pharmacy Medication Request Customer Service: 1-800-288-2078 Fax Order Submission: 3122811636 The member's current signs/ symptoms or chief complaint as __ __ LOGIN __ REGISTER Members Employers Benefits ConsultantsProviders
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Allied is a national healthcare solutions company that supportshealthy workplace
cultures. As problem-solvers, innovators and collaborators, our teampairs
innovative solutions and data analytics that inspire creativesolutions.
In collaboration with clients and benefits consultants, we institute the right plan to support the best options for employees and their families. Every organization has unique needs and challenges. We work with your team to develop solutions that address your specific needs andobjectives.
Our suite of health, wellness and cost management solutions keep members happy and healthy. We deliver informative analytics and detailed monthly reporting to stakeholders via a simple, intuitive user interface.NETWORK PARTNERS
Select from several national networks, including Aetna, Blue Cross Blue Shield (trust and labor) and Cigna, as well as a variety of high performing regional networks.RESOURCES
Access our comprehensive toolkit to make informed decisions for yourhealth plan.
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Allied team members are problem-solvers, innovators and collaborators. We support a culture of knowledge and creativity with competitive pay packages, a robust benefits package and a flexible work environment. Explore current career opportunities at Allied.CONTACT
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