Claim Submission Instructions

Medical Claims For services rendered to participants enrolled in either the Personal Choice^TM or Keystone Health Plan East^TM benefit programs, claims should be submitted through those respective programs. “Blue Card” claims should be submitted through the local Blue Cross plan. Dental Claims Panel members should submit claims to Louis P. Mattucci & Associates. Non-panel members may submit claims on Form ADA J510 (or a similar version), directly to the Fund office. Alternatively, the Fund’s dental claim form may be used. For a copy, click here. Vision Claims Vision claims should be submitted on the Fund’s vision claim form. For a copy of that form, click here.