Aps claims 2026

1. Click ‘Get Form’ to open the APS HealthCare Claims Submission Form in the editor.
2. Begin by entering the date of submission at the top of the form. This helps track your claim effectively.
3. Fill in the Patient Name and Patient’s Date of Birth accurately to ensure proper identification.
4. Enter your Subscriber’s APS ID #, which is essential for processing your claim.
5. Attach an itemized provider bill that includes all required details: charges for services rendered, dates of service, provider information (name, credentials, tax ID #, and address), ICD-9 Diagnosis, and CPT code.
6. If applicable, remember not to sign Box 13 if submitting a CMS 1500 form with this cover sheet. If you want direct reimbursement to your provider, sign Box 13 on the CMS 1500 form instead.
7. Once completed, send your claims to the specified address: APS/SOM Claims Unit, P.O. Box 1440, Rockville, MD 20849-1440.

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