PO Box 5010 Farmington, MO 63640 -5010 . Ambetter from Coordinated Care Attn: Level II – Claim Dispute PO Box 5000 Farmington, MO 63640 . Title: Provider Request for Reconsideration and Claim Dispute Form Author: Coordinated Care Subject: Reconsideration and Claim Dispute Form Keywords:The mailing address of the Ellen DeGeneres Show for fan mail is: The Ellen DeGeneres Show, PO Box 7788; Burbank, California 91522, Attn: Fan Mail. Please note that the above addres...

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P.O. Box 6300 . Farmington, MO 63640-6806 . Paper claims must be submitted on CMS standardized claim forms, using a CMS-1500 or CMS-1450/UB-04 claim form. Electronic claims can be submitted through the following: • Secure Provider Portal: Provider.SuperiorHealthPlan.comClaim, PO Box 3090, Farmington MO 63640-3800 . Provider Services Department: 1-866-912-6285 or www.magnoliahealthplan.com. 6. CLAIMS FILING INSTRUCTIONS • The claim must clearly be marked as “RE-SUBMISSION” and must include the original claim number or the original EOP must be included with the

PO Box 3002 Farmington, MO 63640-3802. 7. Behavioral Health Claim Submission Electronic Submission: • Payer ID 68068 ... PO Box 6800 Farmington, MO 63640-3818 Claim Inquiries: • Check status online • Call Provider Services at 1-877-647-4848 8 . Claim Billing with Ease PO Box 8050 Farmington, MO 63640-8050. Payor ID: 68069. Provider Portal. provider.wellcarecomplete.com. Provider Services Call Center. DSNP Plans: 1 -844-796-6811

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PO Box 3000 . Farmington, MO 63640-3800 .]