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Chemical
Dependency and Mental Health Claims Submission Guidelines
A
claim for chemical dependency for mental health benefits should be filed with
the Health Plan's chemical dependency and mental health benefit manager,
PacifiCare Behavioral Health, following the instructions below:
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Download
and print the HCFA-1500 Form (Adobe Acrobat reader required, click here
for free download).
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Complete
the form in its entirety and submit it along with your provider's bill
(including itemized diagnoses and payment sheets) to PacifiCare at
following address:
PacifiCare
Behavioral Health
P.O. Box 31053
Laguna Hills, CA 92654
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