For claim submissions, please check the member's ID card for the specific submission address. Certain PPO claims must be sent to the repricing address prior to processing by Significa Benefit Services. Claims status and eligibility information requests for Significa Benefit Services should be submitted electronically via Change Healthcare. You will find additional information about Change Healthcare on our Provider page.
Significa Benefit Services, LLC.
P.O. Box 7777
Lancaster, PA 17604-7777
Office Hours: 8:30 a.m. to 5:00 p.m.
Phone: 800.433.3746 or 717.581.1300
The claims submission address (typically found on the back of the member's ID card) is determined by who performs the PPO repricing. For PPO repricing that is performed by Significa Benefit Services, the claims can be sent directly. For PPOs that perform their own repricing, the claim must be submitted to the repricing address as it appears on the member's ID card.
Precertification may be required for certain services and varies from plan to plan. The precertification telephone number is listed on the back of the member's ID card. We recommend contacting the UR vendor with only precertification questions.
No. Precertification is a provision of the plan that reviews medical necessity
and appropriateness as well as standards of care and utilization/service levels. A
service can be medically necessary and appropriate and still not be an eligible expense
under the plan.
If you need to determine if a high cost procedure is eligible under the plan, submit a request in writing to Significa Benefit Services. Your request will be reviewed promptly and a written response will follow.
A delay in claims payment will result if Significa Benefit Services does not have your latest W-9 information on file. If you are a new provider or if your practice has experienced business changes, please fax an updated W-9 to (717) 581-8379.