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Po box 21146 eagan mn 55121 - 1445 Jessamine LLC dba Alexander & Haberman. Dental Insurance, Life Insura

P.O. Box 21660, Eagan, MN 55121-0660 Fax: 402-496-8199 How to file a

P.O. Box 211468 Eagan, MN 55121 • Filing deadline is 90 days from the date of service. • Professional services (CPT) must be submitted on a CMS-1500 claim form. • Inpatient services must be submitted on a UB-04 claim form. • Handwritten submissions will be rejected. • Do not use labels, stickers, or stamps on the claim form.... MN, 55806. 166, ALLAN B COVERT, USPS, 269 OLD TURNPIKE ... PO BOX 91127, ATLANTA, GA, 30364. 1072, BRITTON D MOORER, USPS ... 21146. 1353, CEZAR A ALHAMBRA, USPS ...P.O. Box 21974 • Eagan, MN 55121. INSTRUCTIONS Your provider may submit claims directly to Independence Administrators. You should submit this claim form only when your provider does not submit a claim for you. 1.Please attach itemized bills to this claim form. These bills should include thePO Box 21542 Eagan, MN 55121 Payor ID 44054. New features added to the IVR (Interactive Voice Response) system. We have added new automated features to make verifying your provider information quick and easy. You can now access the following through our IVR system, after following the requested phone prompts: Fee schedule fax back; Location ...PO Box 211438 Eagan, MN 55121; Or fax to 608-276-9119 Attention: New claims; For other claims correspondence use the Claims Resubmission Form (located below) and submit it via secure file upload by clicking on the button below. Secure File Upload. Claim Resubmission Request Form.NEW Mailing Address (Provider Alert 9.5.2019) Health Plan of San Joaquin (HPSJ) has a new mailing address for initial and corrected paper claim (s) submissions. Effective October 1, 2019 all paper claim submissions should be mailed to: Health Plan of San Joaquin (HPSJ) Paper Processing Facility P.O. Box 211395 Eagan, MN 55121 All claims should ...PO Box 211404 Eagan, MN, 55121. Attachment/Appeal Fax# Fax to 952-992-2836 or E-Mail to [email protected] Utilization Management and Clinical Appeals PO Box 9310 CP440 Minneapolis, MN 55440. Electronic Appeal Submission: Dean Health Plan: providerauth.deancare.com. Prevea360: providerauth.prevea360.comP.O. Box 211256 Eagan, MN 55121 OR Excellus Health Plan, Inc. EDI Solutions P.O. Box 21146 Eagan, MN 55121. It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter. Waiting for a ResponseP.O. Box 21146 Eagan, MN 55121-0146 Attn: Form 1095-B Request. Call Us.PO Box 211116 Eagan, MN 55121. Dental, Vision, and Hearing Claims. Phone. 833-653-6338. Fax. 833-517-1852. Email. [email protected]. Mailing Address. Careington Benefit Solutions PO Box 21681 Eagan, MN 55121. FedEX/UPS. Mailing Address. LifeShield National Insurance Co 5500 N. Western Ave, Suite 200916-677-2500. Mailing Address: PO Box 211012. Eagan, MN 55121. The County of Sonoma's Workers' Compensation program compensates employees for disability leave and medical treatment as a result of a work-related injury or illness. Workers’ Compensation benefit regulations are established by the State of California’s Division of Workers ...We can help you get coverage. Call: 1-800-650-4359 711. Monday - Friday: 8 a.m. - 6 p.m. Closed. Child Health Plus is a New York State-sponsored health insurance program that offers free or low cost health insurance for children up to age 19.To submit this form by mail, return to PO Box 21146, Eagan, MN 55121 Claim adjustments, if completed, will be reflected on your next remittance and online at Provider.ExcellusBCBS.com. A nonprofit independent licensee of the BlueCross BlueShield Association Rev. August 2021PO BOX 21146 Eagan, MN 55121 Our Billing/Payment Address: Please refer to the address on your invoice. ... P.O. Box 21146, Eagan MN 55121. 4. FIRST-CALL RESOLUTION: First-call resolution is our goal. We are committed to resolving your inquiry during your initial call. We :ZIP Codes for EAGAN, Minnesota. Use our address lookup or code list to find the correct 5-digit or 9-digit (ZIP+4) code for your postal mails destination. ... EAGAN MN 55121-1551. Map. Census data for EAGAN, MN. Demographic and housing estimates in EAGAN, MN. Total population; Total population: 66,363: Male: 32,263: Female: 34,100:P 800.288.2078 F Allied Benefit Systems, LLC P.O. Box 211651 Eagan, MN 55121 E [email protected] Group Number Employer Location (if applicable) Employee UID or SSN Flex Plan Year Address City State Zip Dental/Vision Provider's Signature (or attach receipt)55121-0000. AMERISCRIPT. H07. PO BOX 2410. STOW. OH ... TPA FOR BC/BS OF MN. PO BOX 64668. ST PAUL. MN. 55164 ... PO BOX 21146. EAGAN. MN. 55121-0000. EXCELLUS ...Mail completed form and any supporting documentation to: P.O. Box 21146, Eagan, MN 55121-1146 Customer Submitted Dental Claim Form Mail Completed Forms to: P.O. Box 21146, Eagan, MN 55121 Subscriber Information (from ID card) Subscriber ID Subscriber Last Name Subscriber First Name Subscriber Address Subscriber City, State, ZipHealthEZ: PO Box 211186, Eagan, MN 55121 PRIMARY MEDICAL NETWORK: America's PPO AmericasPPO.com TRAVEL MEDICAL NETWORK: PI-ICS Out of Area 800-678-7427, MultiPlan.comlHealthEZ PHARMACY: WellDyne 888-479-2000, WellDyne.com Out Of Area welldyne Administered by: health Policy Holder: Group: Subscriber:p.o. box 211517 eagan, mn 55121-2717 if sending by facsimile, fax to: 915-532-0159 employee name employer ssn address phone city state zip email claim is for: employee spouse child claimant's date of birth if this claim is for a child over 19 years of age, is the child a full-time student? yes no if yes, school nameMail disputes to: Provider Disputes, PO Box 211624, Eagan MN 55121. For electronic instructions and submission, visit Sutter Link. ... PO Box 14165 Lexington, KY 40512-4165 (800) 949-2961 (Fax) Stanford Health Care Advantage Claims Attn: Non-Contracted Provider Appeals P.O. Box 71210another approved EDI vendor, or mail paper claims to: SOMOS, P.O. Box 21432, Eagan, MN 55121 Note: Your participation in SOMOS IPA does not affect your relationship with Anthem (Empire BCBS) for patients with other lines of business, such as commercial insurance or Medicare Advantage, or dual-eligible Medicare/Medicaid …PO Box 211702 Eagan, MN 55121 Phone: 800-261-3371. More claims information. Emergency Room Auto-Pay List. Electronic Claims Submission. Claims and Refunds. ICD-10 Update. Observation Authorization. National Drug Code NDC. Information current as of: 01/19/2023. Feedback. Interoperability.PO Box 21747, Eagan, Minnesota, 55121, United S... Website www.planstin.com. Revenue <$5 Million. Industry Insurance . Recent News & Media. No recent news or media. Overview ; Org Chart ; Similar Companies ; Who is Planstin. Planstin administers a self-funded Vision Plan which is designed to provide care for your regular vision needs.Provider Relations Directory. Dominion National : 888.471.3631. Dominion USA, Inc. (formerly DentaQuest Mid-Atlantic and Virginia): 888.471.3631. Providence Health Plan: 855.612.7478. Premera Blue Cross: 855.612.7477. Get in touch with a customer service representative fast. Contact Dominion National through our secure online form.You will receive your Form 1095-B within 30 days. P.O. Box 21146 Eagan, MN 55121-0146. Attn: Form 1095-B Request. Call Us. If your employer provides your ...Advocacy Department Attn: Civil Rights Coordinator PO Box 4717 Syracuse, NY 13221 Telephone number: 1-800-614-6575 TTY number: 1-800-421-1220 Fax: 1-315-671-6656. You can file a grievance in person or by mail or fax. If you need help filing a grievance, the Health Plan’s Civil Rights Coordinator is available to help you.PO Box 21063 Eagan, MN 55121. Fax: 1-855-969-5853. Call us to expedite an appeal: Longevity Health Plan of Florida: ...Saint Paul, MN 55121 - Peer Comparisons by Rank and Percentile. The table below compares 55121 to the other 878 ZIP Codes in Minnesota by rank and percentile using July 1, 2023 data. The location Ranked # 1 has the highest value. A location that ranks higher than 75% of its peers would be in the 75th percentile of the peer group.P.O. Box 21146 Eagan, MN 55121. Our Corporate Street Address: In the Central New York and Southern Tier Regions: Excellus BlueCross BlueShield 333 Butternut Drive Syracuse, NY 13214-1803. In the Rochester Region and Nationwide: Excellus BlueCross BlueShield 165 Court Street Rochester, New York 14647. In the Utica Region: Excellus BlueCross ...PO Box 211342 Eagan, MN 55121-1342 • 1. MyBSWHealth app or MyBSWHealth.com Prior Authorization: • Visit the provider portal Fax: 800-626-3042 Phone: 888-316-7947 Provider Portal: FOR MEMBERS Possession of this card or obtaining precertification does Important Information: n a medical emergency, call 911 or go to the nearestMEMBER IDPO Box 30783 Salt Lake City, UT 84130-0783. Medical claims rendered by in and/or out-of-network providers: UnitedHealthcare Choice Plus (all states except California) ... P.O. Box 21542 Eagan, MN 55121. UnitedHealthcare Choice Plus (all 50 …P.O. Box 211747 Eagan, MN 55121. Sales & Product Inquiries. Lakeshore Benefit Alliance, LLC Phone: (205) 703-9300. Links. Kaiser Health News; Modern Healthcare; The New York Time - Health Care Reform News; Healthcare Bluebook; Commonwealth Fund; Noteworthy Headlines.PO Box 21063 Eagan, MN 55121. Fax: 1-855-969-5853. Call us to expedite an appeal: Longevity Health Plan of Florida: ...Fast and FREE public record search on Po Box 21186 Eagan MN 55121. Get contact info for current residents, including phone, email & criminal records. 100% Free!Excellus BlueCross BlueShield PO Box 21146 Eagan, MN 55121 . Updated 04/02/2024 . Author: Patricia Laskowski Created Date: 4/2/2024 4:13:46 PM ...PO Box 21342 . Eagan, MN 55121- 0342 . Electronic payer ID: MEDM1. For those members who are "dual-eligible" (i.e., have Medicare eligibility that is not integrated with their Medical Assistance managed care), Medica will coordinate benefits with their primary . Medicare coverage provider. Medica receives these coordination of benefits (COB ...PROVIDER CONTACT INFORMATION MEMBER INFORMATION. CODING CORRECTION/REVIEW. For all claims, send form to: Quartz, Attn: Recoveries, P.O. Box 211221, Eagan, MN 55121 or fax to (608) 643-2564 Please attach a copy of any necessary supporting documentation and/or a corrected claim. Created Date. 5/7/2019 2:30:18 PM.Providers must submit the applicable, completed and legible forms to: ElderServe Health, Inc. d/b/a RiverSpring Health Plans. PO Box 211465. Eagan, MN 55121. Providers may also submit and track paper claims through Smart Data Stream at no cost. To use this option, providers must register on the site with the following link:P.O. Box 211256 Eagan, MN 55121 OR Excellus Health Plan, Inc. EDI Solutions P.O. Box 21146 Eagan, MN 55121 . It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter. Waiting for a ResponsePO Box 21426 Eagan, MN 55121 Phone Number: (866) 236-2673 Website: File a Claim . My pharmacy claim was denied. What do I do? If your claim was denied, please follow the instructions on the rejection code or call AlphaScrip's Help Desk at (877) 274-3244. Ensure you are submitting the correct information (e.g., the correct BIN or Member ID ...PO Box 211609. Eagan, MN 55121 . For Customer Service: (866) 919-9159. Contact Us. Go Up. bottom of page ...Providers must submit the applicable, completed and legible forms to: ElderServe Health, Inc. d/b/a RiverSpring Health Plans. PO Box 211465. Eagan, MN 55121. Providers may also submit and track paper claims through Smart Data Stream at no cost. To use this option, providers must register on the site with the following link:EDI Payor ID: 56071 Mail Claims to: American Family Mutual Insurance Company PO Box 21801 Eagan, MN 55121-0801SimplyBlue Copay & Copay/Deductible. A nonprofit independent licensee of the BlueCross BlueShield Association GROUP ENROLLMENT FORM. P.O. Box 21146, Eagan, MN 55121. Instructions on last page. All Dates = mm/dd/yy PLEASE PRINT CLEARLY. 1 -. Group Employer Information. This section should be completed by the Group Benefits Administrator.PO Box 211404 Eagan, MN, 55121. Attachment/Appeal Fax# Fax to 952-992-2836 or E-Mail to [email protected] Utilization Management and Clinical Appeals PO Box 9310 CP440 Minneapolis, MN 55440. Electronic Appeal Submission: Dean Health Plan: providerauth.deancare.com. Prevea360: providerauth.prevea360.comPO Box 211116 Eagan, MN 55121. Dental, Vision, and Hearing Claims. Phone. 833-653-6338. Fax. 833-517-1852. Email. [email protected]. Mailing Address. Careington Benefit Solutions PO Box 21681 Eagan, MN 55121. FedEX/UPS. Mailing Address. LifeShield National Insurance Co 5500 N. Western Ave, Suite 200PO Box 211609. Eagan, MN 55121 . For Customer Service: (866) 919-9159. Contact Us. Go Up. bottom of page ...P.O. Box 21545 Eagan, MN 55121. Payer ID provider number reference — Facility Rev. April 2023 Use this guide as a reference tool when submitting facility claims. This information was current at the time of publication. We will announce changes on the Provider News Center and the Provider Engagement, Analytics & Reporting (PEAR) portal.For more than 30 years, Fringe Benefit Group has designed programs that simplify the benefits process for employers with hourly workers. We offer products from the nation's leading carriers, and we are known for our full-service suite of tools and services that greatly reduce the burden of plan enrollment and administration. Read More.NPI # – Box 33A Blue Cross® Independence QMO MedigapFreedom 54704 54704 Claims Receipt Center P.O. Box 211184 Eagan, MN 55121 Blue Shield® Highmark QCA QCC Traditional Blue Cross® Blue Shield® Concurrent Major Medical 54771 54771 Highmark Blue Shield P.O. Box 890062 Camp Hill, PA 17089-0062 QCE Security 65®, 65 Special, and ...P.O. Box 211395 Eagan, MN 55121. All claims should be submitted electronically, unless required documentation is needed to process claim. Find our EDI vendor information through one of the following: Office Ally Payer ID: HPSJ1 (866-575-4120) Change Healthcare (EMDEON) Payer ID: 68035 (877-469-3263) Questions? HPSJ …(651) 688-9600 Visit Website Map & Directions Po Box 211533 Saint Paul, MN 55121 Write a Review. Is this your business? Customize this page. Claim This Business Hours. Regular Hours. Mon - Fri: 9:00 am - 5:00 pm: Places Near Saint Paul with Similar Businesses. Mendota (5 miles) Lilydale (9 miles)PO Box 21482 Eagan, MN 55121 Payer ID (for EDI claims): SX110. What if I disagree with the way my claim is paid? You may request a review of any adverse claim decision by following the claims review procedure, as outlined in the Provider Handbook. What portion is the insured responsible for paying?P.O. Box 211747 Eagan, MN 55121 Standard Life & Accident Insurance Company P.O. Box 211748 Eagan, MN 55121 Claims Payment: If you send documentation showing you have paid the provider along with the EOBs and the provider statement, we will pay the benefit to you. Claims info can be sent to MWG Administrators via: ...Eagan, MN 55121. Home Care Providers Only. Submit claims by email: [email protected]. Reimbursements. PACE programs are required by federal regulations to have a Provider Network to meet the needs of our participants. If you need another copy of our contract please contact Rena Wright at (336) 550-4047 or [email protected]. Box 211424 Eagan, MN 55121. Please Mail Non-Claims Items To: Dominion National P.O. Box 21522 Eagan, MN 55121. Corporate Headquarters: Dominion National 251 18th ...Mailing ADDRESS. Empower Healthcare Solutions P.O. BOX 211446. Eagan, MN 55121 ... Department of Medical Services. Donaghey Plaza P.O. Box 1437, Slot S401 Little ..._____Employs 100 or more If Member does not have Medicare please indicate reason for not having Medicare: _____ ___A. Active Employee Medicare Beneficiary Identifier ...Mail……………………..……………………… PO Box 21146, Eagan, MN 55121 When you contact us, you must: • Tell us how you want to get notices that are normally sent by …You may submit a request outside of regular business hours and on weekends at: 1-877-883-9577 (TTY: 711.) You may fax a request to: 1-877-203-9401. You may mail a request to: Excellus BCBS. Attention: Utilization Management. P.O. Box 21146. Eagan, MN 55121.PO Box 211524 Eagan, MN 55121. Send any mail via USPS to making delivery. More mail carriers don’t deliver to PO choose. Using Availity . Log in till Availity to enter claims, impede member eligibility, enroll to Electronics Remittance Advice (ERA), access electronic versions of Declarations of Payments (EOPs), and request ...P.O. Box 211256 Eagan, MN 55121 OR Excellus Health Plan, Inc. EDI Solutions P.O. Box 21146 Eagan, MN 55121 . It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter. Waiting for a ResponseP.O. Box 211395 Eagan, MN 55121. All claims should be submitted electronically, unless required documentation is needed to process claim. Find our EDI vendor information through one of the following: Office Ally Payer ID: HPSJ1 (866-575-4120) Change Healthcare (EMDEON) Payer ID: 68035 (877-469-3263) Questions? HPSJ Customer Service, 209-942-6320.A treatment known as median nerve stimulation (MNS) can significantly reduce tic frequency, tic intensity and A treatment known as median nerve stimulation (MNS) can significantly ...Legal Notice : All products are underwritten and issued by Freedom Life Insurance Company of America, National Foundation Life Insurance Company and Enterprise Life Insurance Company, wholly owned subsidiaries of USHEALTH Group, Inc. All products not available in all states. Contact a Licensed Insurance Agent for additional information.P.O. Box 21522 | Eagan, MN 55121-0522. AFFILIATIONS AND RECOGNITION ©2024 Dominion National Dominion National is the brand name for the Dominion group of companies. Dental plans are underwritten by Dominion Dental Services, Inc. (DDSI). Dominion Dental Services USA, Inc. (DDSUSA) is a licensed administrator of dental and vision benefits.PO Box 21146 Eagan, MN 55121. Form: RCOB Rev. 10/17 . A11y 10/18/2019. [email protected] . Title: Request for Reconsideration of a Denied or Retracted Coordination of Benefits Claim When the Other Carrier Information is Unclear Author: Excellus Blue Cross Blue Shieldapproved EDI vendor, or mail paper claims to: SOMOS IPA, LLC, P.O. Box 211473, Eagan, MN 55121 Note: Your participation in SOMOS IPA does not affect your relationship with EmblemHealth for patients with other lines of business, such as commercial insurance or Medicare Advantage, or dual-eligible Medicare/Medicaid patients.PO Box 21545|Eagan, MN 55121 Fax ##215-784-0672. Approval Process. After the request is submitted, the service or drug is reviewed to determine if it: is covered by the health plan, and; meets the health plan's definition of "medically necessary." The prior authorization is then completed, and the results are sent to the provider.Jul 4, 2023 ... ... PO Box 644",,Marshall,MN,56258,512.3470 ... Eagan,MN,55121,99.6300,.0000,03/05/2018 ... Severna Park",MD,,150.0000,.0000,05/06/2022,"Internet&nbs...PO Box 211342 Eagan, MN 55121 Customer Service: 800-321-7947 Prior Authorization: Visit the provider portal Fax: 800-626-3042 Phone: 866-384-3488 Provider Portal: Card Issue Date: 08/01/2020 FOR MEMBERS not guarantee coverage or payment for the service or procedure reviewed.Dec 15, 2023 · PO Box 21327 Eagan, MN 55121. You can also file a complaint with Medicare directly. If you want to let Medicare know about problems you’re having with your Devoted Health plan, fill out the Medicare Complaint Form or call 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week. If your complaint involves a broker or agent, be sure ...Mail completed form and any supporting documentation to: P.O. Box 21146, Eagan, MN 55121-1146 Customer Submitted Dental Claim Form Mail Completed Forms to: P.O. Box 21146, Eagan, MN 55121 Subscriber Information (from ID card) Subscriber ID Subscriber Last Name Subscriber First Name Subscriber Address Subscriber City, State, ZipMail this form and attachment(s) to: PO Box 21146, Eagan, MN 55121. A nonprofit independent licensee of the BlueCross BlueShield Association . B-2761 . Rev 03.21P.O. Box 211592 Eagan, MN 55121-2892 Payer ID 06541 CountyCare Provider Quick Reference Guide January 2021 Page 1 of 2 Provider Services CountyCare Website Visit for documents, forms, important health plan information, and provider and member resources. https://www.countycare.comPO Box 211698 Eagan, MN 55121 Intra-clinic Mailing Address: Health Care Flexible Spending Account Claims Mayo Support Center North SN 3 Phone: 6-6360 (on Mayo Clinic campus) (77)6-6360 (on other Mayo Clinic campus) 507-266-5580 (local) 1-800-635-6671 (toll-free),1-800-407-2442 (TDD)A treatment known as median nerve stimulation (MNS) can significantly reduce tic frequency, tic intensity and A treatment known as median nerve stimulation (MNS) can significantly ...QUARTZ main address is PO Box 211221, Eagan, Minnesota 55121, main phone number 844-644-3455. This is the best QUARTZ Phone Number phone number where you can speak to a real person and get assistance with your medical insurance issue.SimplyBlue Copay & Copay/Deductible. A nonprofit independent licensee of the BlueCross BlueShield Association GROUP ENROLLMENT FORM. P.O. Box 21146, Eagan, MN 55121. Instructions on last page. All Dates = mm/dd/yy PLEASE PRINT CLEARLY. 1 –. Group Employer Information. This section should be completed by the Group Benefits …PO Box 21063, Eagan, MN 55121 Para información en español llame CommuniCare Advantage al (855) 969-5861 (TTY:711) Call Member Services toll-free between 8:00 a.m. and 8:00 p.m. seven days a week October 1st through March 31st (Monday through Friday April 1st through September 30th) ...P.O. Box 21146 Eagan, MN 55121-0146 . Mail completed form and all required information to: 1a-HAVE SUBMITTED EXPENSES BEEN PAID IN FULL BY YOU? YES . NO. Please Note-If a participating provider rendered the service(s) being submitted, payment will be made directly to the provider.You may submit claims to Surest (365-day timely filing) fully by Surest payer LICENSE 25463 or by mail to: PO Box 211758 Eagan, MN 55121 After a claim has been submitted, quickly check claims status on UHCprovider.com or shout 1-844-368-6661 toward address with one specially skilled Steady Provider Services representative.PO Box 211609. Eagan, MN 55121 . For Customer Service: (866) 919-9159. Contact Us. Go Up. bottom of page ...P.O. Box 21146 Eagan, MN 55121-0146 Attn: Form 1095-B Request. Call Us.In this issue: Medi/Medi Claim Submissions Newborn Claims/Eligibi, PO Box 211702 Eagan, MN 55121 Phone: 800-261-3371. More, P.O. Box 211468 Eagan, MN 55121 • Filing deadline is 90 days from the date of se, P.O. Box 21341 Eagan, MN 55121. WPS Administrative Services WPS , Hours: Monday - Thursday 8:00 am - 5:30 pm PO Box 21146 Friday 9:00 am - 5:30 pm Eagan, MN , 888-920-7526. Available Mon-Fri 7:00 AM - 6:00 PM MST. Contact Planstin Administration for all your e, While we highly encourage electronic claim submissions, , P.O. Box 21185 Eagan, MN 55121 Customer Service Toll free: 1-80, Submit to: AmeriHealth Administrators Administrativ, Mail completed form and any supporting documentati, P.O. Box 21661. Eagan, MN 55121. Visit Website (866) 228-3142. Cu, Apr 1, 2019 ... Eagan, MN 55121-2908. USA. Family Hea, o Mail: Send paper claims to SOMOS IPA, LLC, P.O. Box 21432, Ea, PO Box 21146 Eagan, MN 55121-0146 ExcellusBCBS.com . FORM -, A provider dispute is a written notice from a provider that c, P.O. Box 211256 Eagan, MN 55121 . Mail Forms and Payments. Dir, PO Box 211316 Eagan, MN 55121 A nonprofit independent licen, PO Box 21146 Eagan, MN 55121-0146 ExcellusBCBS.com . FORM - MXCNY. M.