Coastal TPA, Inc. is pleased to provide a self service online tool, which is HIPAA compliant for patient privacy, and provides you with free online access to your benefit information. Take a minute and review the exciting online services available to you.
Member/Provider Log-in:
System features allow members to:
View paid claim information
Check eligibility status
Retrieve the summary plan description
Access to online customer service
Verify provider participation
And much, much more!
How to Submit a Claim to Coastal
Coastal makes claims submission easy for our members. Most providers will even submit claims on your behalf.
If you are a member, and your provider of service has submitted a claim for you, then there is no need to fill out and submit a claim form.
CLAIM FORMS: Please use these forms if you need to send your provider the appropriate claim form for their use:
forms require Adobe Reader, 
click here to download Adobe Reader
If you are a member and are submitting your own claims:
- Please print out and complete the member claim form. You can find complete instructions here if needed.
- You will also need to attach an itemized bill from the provider of service that includes patient name, provider name/ address/ provider’s taxpayer identification number, date(s) of service, diagnosis code(s), (primary/secondary) describing the condition, procedures codes(s), place of service and itemized charges.
- If the patient has other coverage, please attach a copy of the other claims administrator’s explanation of benefits. This information is required to process your claim.
- Please submit your claim and the attachments to:
Coastal TPA, Inc.
P.O. Box 80308
Salinas, CA 93912-0308
Coastal ensures compliance with HIPAA regulations to protect patient privacy. If you have questions about a claim that was submitted on behalf of an adult (over 18 years old) family member, please have them complete and sign this Privacy Release Authorization.
Forms:
forms require Adobe Reader, click here to download Adobe Reader
