95 • Name a specific individual participant and his/her Social Security Number or other assigned unique identification number; • Name a specific claimant and his/her date of birth; • Name a specific medical condition or symptom; • Provide a description and date of a specific treatment, service or product for which approval or payment is requested (must include an itemized detail of charges and applicable service codes); • Identify the provider’s name, address, phone number, professional degree or license, and federal tax identification number (TIN); and • When another plan is primary payer, include a copy of the other Plan’s Explanation of Benefits (EOB) statement along with the submitted claim. A request is not a claim if it is: • Not made in accordance with the Plan’s benefit claims filing procedures described in this section; • Made by someone other than you, your covered dependent, or your (or your covered dependent’s) authorized representative; • Made by a person who will not identify himself or herself (anonymous); • A casual inquiry about benefits such as verification of whether a service/item is a covered benefit or the estimated allowed cost for a service; • A request for prior approval where prior approval is not required by the Plan; • An eligibility inquiry that does not request benefits. However, if a benefit claim is denied on the grounds of lack of eligibility, it is treated as an adverse benefit determination and the individual will be notified of the decision and allowed to file an appeal; • The presentation of a prescription to a retail pharmacy or mail order pharmacy that the pharmacy denies at the point of sale. After the denial by the pharmacy, you may file a claim with the Plan. If you submit a claim that is not complete or lacks required supporting documents, the Plan Administrator or Claims Administrator, as applicable, will notify you about what information is necessary to complete the claim. This does not apply to simple inquiries about the Plan’s provisions that are unrelated to any specific benefit claim or which relate to proposed or anticipated treatment or services that do not require prior approval. How to File a Claim Please make sure that you present your benefit identification card to each provider before you are given any services so that the provider will know that you participate in a CareFirst Administrators Preferred Provider Organization. Non-Preferred Providers may require that you pay them first and that you seek reimbursement by filing your own claim with CareFirst Administrators. Network Benefits If you use CareFirst Administrators network providers, your claim for benefits will go directly from the network health care provider (hospital, physician, laboratory, etc.), through an automated electronic