The forms below are provided to assist you in completing claim-related needs.
If you have any questions regarding these forms, please call our Benefits Administration Department at 1-800-707-7726 and select Option 2.
These forms should only be used if Crescent Health Solutions is your Benefits Administrator; for any other claims payer, please refer to the contact information listed on your health plan ID card.
Dental Claim Form - PDF
Medical Claim Form - PDF
Medical Claim Form - PDF-fillable
If your provider is Out-of-Network, you may submit the form below and Crescent Health Solutions will work with the provider if they are interested in joining the network.