Submitting Claims
How to Submit Claims:
The information needed to submit claims to Custom Design Benefits is included on each member’s customized ID Card. To see a map of our typical ID Card, please click here. It is important to review the member’s ID Card at each visit even though Custom Design Benefits is the TPA. Other information and instructions may have changed since the member’s last visit.
In some cases, your claim may need to be directed to the PPO network first for repricing prior to coming to Custom Design Benefits. It is very important that the Employer’s name and complete group number be included on your claim. This helps the PPO route claims to us.
If claims do not need to go to the PPO first (see member’s ID Card), you can send claims to:
Custom Design Benefits, Inc.
3737 West Fork Road
Cincinnati, OH 45247
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Prior Authorization of Services
We can verify whether a service needs prior authorization or pre-certification during benefit verification. Each plan is different, so it is important to confirm whether prior authorization or pre-certification is needed so that benefits are not reduced. In general, most of our plans require prior authorization for the following:
- Hospitalizations (including Emergency Admissions within 72 hours)
- Skilled Nursing Facility stays
- Home Health Care
- Hospice Care
- Hyperbaric Oxygen (HBO) Therapy
- Durable Medical Equipment over $750
- Capsule Endoscopy
- Sleep Studies and Sleep Disorders
- Bone Growth and Neuromuscular Stimulator
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Contact Us
Our hours of operation are 8:30 am to 5:00 pm EST, Monday through Friday
513-598-2929 Local Cincinnati Area
800-598-2929 Toll-Free
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