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address where services were provided and Tax Identification Number (TIN) z Detailed invoice including CPT code or description of services and diagnosis code How to submit a claim online 1. To reach us by phone, dial the toll-free number on the back of the patient's ID card. <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 4 0 R /Rect[ 397.92 348.36 453.6 370.56]/Subtype/Widget/T(Group Number_2)/TU(Group Number)/Type/Annot>>
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