You need to download and print your ID Card & Claim Form from your PSI online account then submit Medical Claims by Mail or Electronically:
BY MAIL - Send this Claim Form & All Itemized Bills to:
First Student P.O. Box 809025 Dallas, TX 75380-9025
Please fill out the entire first page and be sure to indicate your current address when you submit this. Your doctor will need to fill out the second page of the form
ELECTRONICALLY - Doctors/Hospitals can also submit a claim electronically, using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. Electronic Data interchange (EDI) Payor ID: 74227
You can check your claim status by calling First Student at 1-800-505-4160 or email customerservice@uhcsr.com.
1. Always bring your PSI ID Card & Claim Form when you visit the hospital. You can download this from your PSI online account.
2. If you pay for your medical bills upfront, please complete a Claim Form and attached all itemized bills, statements, and receipts attached, and send it to our claims division by Mail. For details on how to file claims, please click here
3. If a Preferred Provider is not available in the Network Area, benefits will be paid at the level of benefits shown as Preferred Provider benefits. Please keep in mind, although the website is updated frequently, it does not always reflect the most up to date information. Prior to being seen, you should always confirm the Preferred Provider is part of the network, as this can change without notice by calling 1-800-505-4160 and/or by asking the Doctor/Hospital. Network Area is 50 mile radius around your school campus.
4. If the Covered Medical Expense is incurred due to a Medical Emergency, benefits will be paid at the Preferred Provider level of benefits.
If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of this Prescription Claim Form. After filling
out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided. To submit a Generic Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:
Date prescription filled
Name and address of pharmacy
Doctor name or ID number
NDC number (drug number)
Name of drug and strength
Quantity and days’ supply
Prescription number (Rx number)
DAW (Dispense As Written)
Amount paid
This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide
the necessary information as well.
Please mail completed form and receipt(s) to:
FIRST STUDENT
P.O. Box 809025
Dallas, TX 75380-9025
