State of New York Member Out of Network Claim Submissions

The intended use of this process is for New York State residents to submit their out of network provider claims.

Attention Oxford members in the state of NY: Effective 1/1/2020, please use the following link to submit your out of network provider claims - https://www.personalhealthmessagecenter.com/public/forms/MedicalClaims

Your Name *

Member ID *

As it appears on your membership card.

Group Number *

As it appears on your membership card. If it's not present, please contact customer care.

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Subject *

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Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.