HCFA 1500 Claim Form

To submit a paper claim for outpatient therapy or EAP services to Quest Behavioral Health, download and complete the HCFA 1500 Claim Form below.

Download the HCFA 1500 Claim Form and submit your paper claim for reimbursement.

 


If you do not use a clearinghouse, please submit your paper claims to Quest at the addresses below:

  • Employee Assistance (EAP) claims:
        Quest EAP
        PO Box 864
        Arnold, MD 21012

  • Behavioral Health (non-EAP) claims:
        Quest Behavioral Health
        PO Box 565
        Arnold, MD 21012
To check the status of your claim, please complete the Claim Status Inquiry form or call Quest Claims at 800-364-6352.

Claims may also be submitted to Quest electronically through your clearinghouse using the appropriate payor ID below:

  • Employee Assistance (EAP) claims: 10956
  • Behavioral Health (non-EAP) claims: 44219

To track receipt of your electronic claim, you can register for the ClaimsBridge Portal at www.claimsbridge.net.