Medical Claims Submission - VHP must receive claims and encounter data from contracted providers within ninety (90) days from the date of service. VHP has 45 working days from the date of receipt to reimburse, contest, or deny a claim.
All paper claims for covered services provided to eligible Members must be submitted on CMS 1500 Form (for all professional services, durable medical equipment (DME) and supplies and Laboratory Services) or on UB 04 Form (for all institutional facility charges inpatient/outpatient). All claim forms and claim-related documents, and disputes, must be signed and dated by the provider or a designee.
Claims must be sent to the appropriate address listed below.
- Employer Group Plan Members
VHP Commercial
P.O. Box 26160
San Jose, CA 95159
- Covered California Plan Members
VHP Claims Department
P.O. Box 26160
San Jose, CA 95159
- Individual and Family Plan Members
VHP Claims Department
P.O. Box 26160
San Jose, CA 95159
- Medi-Cal Members
VHP Medi-Cal
P.O. Box 28407
San Jose, CA 95159
- Healthy Kids / Healthy Families
P.O. Box 28410
San Jose, CA 95159