How to File a Claim for a Student/Athletic Injury:
- Download a claim form:
- English Version: here
- Spanish Version: here
- The student MUST see a doctor within 60 days of the injury.
- Follow the instructions on p. 1 of the claim form. Fill in all the information on the claim form and SIGN IT. A school official must also sign the claim form. Send the claim form and itemized bills to the K&K claims department address at the top. Send the form within 90 days of the injury.
- Itemized Bills (Forms UB04, UB92, or HCFA1500, CMS1500) with CPT/Diagnostic Codes from each provider are required for processing.
- If you have other applicable insurance, you must also file with that company. When you receive Explanation of Benefits (EOBs) from your Primary Insurance, forward these to the K&K claims department
- Keep a copy of all paperwork for your records.
Filing a claim after an injury is YOUR responsibility. Do not assume that the provider or a school official will do this for you. Under HIPAA privacy laws, the school or agent cannot obtain claim information from an insurance company or provider without your written permission.
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**An incomplete claim form is the most common reason why claim payments are delayed.**
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