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Health Insurance Claim Forms

Coastal TPA, Inc. is now accepting provider’s claims electronically through a FREE clearinghouse. If providers wish to take advantage of this free service, please contact Office Ally at 949.464.9129, opt 3, or enroll online at www.OfficeAlly.com.

 

To view a form online, simply click on the link below. You must have Adobe Acrobat Reader to view these forms. You may also optionally download the forms to your computer by right-clicking on a link below and selecting "Save As" from the menu.
• HCFA-1450-ub-92.pdf
• HCFA-1500-90.pdf
• Dental Claim Form


 

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928 East Blanco Road, Suite 235
Salinas, CA   93901
Customer Service: (831) 754-3800
Toll Free: (800) 564-7475
Fax: (831) 754-3830
Email: info@coastalmgmt.com