Out-of-Network Claim Form

Submit claims for providers outside the Quest network

 

To submit claims for providers outside the Quest network, download and complete the Out-of-Network Claim Form. Submit the completed form, along with the itemized bill from the provider, to Quest:

 

  • Mail
  • Quest Behavioral Health
  • Attn: Claims Department
  • PO Box 1032
  • York, PA 17405
  • Fax
  • 717-851-1414
  • Attn: Claims Department

For questions, please call Quest Claims Department at 800-364-6352 or 717-851-1480.