96 system, or through the mail, to the Claims Administrator for processing. Generally, you are not required to file a claim form for in-network benefits. Out-of-Network Benefits If you use out-of-network providers not affiliated with the CareFirst Administrators network, you may be required to submit your own completed claim form and follow the claims procedures outlined in this Section, as applicable. You may obtain claim forms from the Fund Office, CareFirst Administrators, or by going online at www.iambtf.org . To expedite the processing of your medical claim, please be sure to complete the form thoroughly, including information about Medicare eligibility and any other group benefits that may be payable on your behalf. Your written claim must be mailed to CareFirst Administrators as soon as reasonably possible after the expense is incurred, but in no event more than one year after the expense is incurred. Note: Any claims CareFirst Administrators receives more than one year after the expense is incurred will be denied as untimely. CareFirst Administrators may also have shorter filing limits for their network providers. You will not be responsible for payment of charges CareFirst Administrators denies for untimely filing if a CareFirst Administrators contracted provider fails to file your claim in accordance with CareFirst Administrator’s contractual requirements. The following information must be completed on the claim form in order for your request for benefits to be considered a claim, and in order for the Plan to be able to process your claim. You complete the Employee portion of the claim form, providing the following: • Participant name; • Patient name; • Participant member id and account number • Patient date of birth; and Note: Your member ID is the ID shown on your benefit identification card. Your physician (or other provider) may either : • Complete the following items, as applicable, on the Attending Physician’s Statement section of the claim form: • Date of Service; • CPT-4 (the code for physician services and other health care services found in the Current Procedural Terminology, Fourth Edition, as maintained and distributed by the American Medical Association); • ICD-10 (the diagnosis code found in the International Classification of Diseases, 10th Edition, Clinical Modification as maintained and distributed by the U.S. Department of Health and Human Services); • Billed charge; • Number of units (for anesthesia and certain other claims);