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.

MEMBER ID# IS A REQUIRED FIELD ON THE HCFA 1500 FORM

Quest does not require a specific number in this field. However, we suggest using the member's ID number found on their benefit card or the last 4 digits of the member's Social Security Number. For a list of required fields, please see the List of HCFA 1500 Required Fields.
 
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 at 800-364-6352 or 717-851-1480.

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.