In an effort to decrease the claims administration turnaround time, the medical and dental claims administrator for HealthChoice, the Department of Corrections and the Department of Rehabilitation Services requires a scan sheet to be attached to all medical or dental records submitted. This requirement is to facilitate quickly matching the records with the correct claim. If records are submitted without the scan sheet, they will be returned to you. Please do not submit records unless they are requested by the claims administrator. A separate scan sheet must be completed for each claim for which you are submitting records.
It is important that the claim number, found on your remittance advice, be included on the form.
The forms are available for download.
2017 and prior, use this scan form.
2018, use this scan form.
If you have questions, please contact the medical and dental claims administrator at 800-285-6815..