How to File a Claim for a Student/Athletic Injury:

  1. Download a claim form:
  2. English Version: here
  3. Spanish Version: here
  4. The student MUST see a doctor within 60 days of the injury.
  5. 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.
  6. Itemized Bills (Forms UB04, UB92, or HCFA1500, CMS1500) with CPT/Diagnostic Codes from each provider are required for processing.
  7. 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
  8. 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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