Primary Insurance - CompuNet files claims to all primary insurance companies as a courtesy to our patients.

Secondary Insurance - CompuNet files secondary insurance claims for a limited number of insurance plans, including Anthem, Cigna, Medical Mutual, Medicare (all plan types), Medicaid (all state and managed care plans), Tricare, and United Healthcare.

Each visit for laboratory testing is a separate account in our computer system. You may be asked to submit your insurance information more than once if you or family members have other accounts with us.

Insurance Change Request

Insurance Type - Select - Primary Secondary
Invoice #
Patient Name

Insurance Information

Insurance Name
Insurance Claims Address Line 1
Insurance Claims Address Line 2
City
State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist. of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMarshall IslandsMassachusettsMichiganMicronesiaMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern MarianasOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip
Policyholder Name
Policyholder Date of Birth
Patient's Relationship to Policyholder - Select - Self Spouse Dependent
Policy/Member ID
Policyholder's Employer
Group Number
Effective Date
Insurance Telephone

Code

(Enter the code from the image below)

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