To whom it may concern:

The patient presenting this notice is a member of the Miles IT Health Plan, a self-funded employer group health plan. Because this plan is self-insured and does not utilize a traditional national PPO network, it may not appear in your standard clearinghouse lookups.

However, this plan provides full coverage for the services being rendered today.

Option 1: Preferred – Direct Billing

We encourage you to bill the plan directly. The patient’s Member ID card contains the necessary electronic payor ID and mailing address for claims.

• Benefits Verification: Please call the Member Support at 866-206-3224 to verify eligibility and benefits immediately.
• Claims Processing: Our Third-Party Administrator (TPA), Imagine360, will adjudicate claims based on Fair Market Pricing.

Option 2: Immediate Payment – Virtual Cash Card (VCC)

If your office is unable or hesitant to bill the plan directly at this time, the patient is authorized to use a Virtual Cash Card (VCC) to facilitate an immediate “Self-Pay” transaction.

ProcessingInstructions for VCC:

1. Treat as Self-Pay: Please treat the patient as a “Self-Pay” or “Time-of-Service” patient for today’s visit.
2. Run the Card: The patient will provide a 16-digit Virtual Card number (Visa/Mastercard). Simply enter this number into your standard credit card terminal.
3. Process the Amount: Swipe or manually enter the card details for the amount of today’s visit.
4. Provide a Receipt: Please provide the patient with an itemized receipt (including CPT and ICD-10 codes) so our TPA can reconcile the payment.

Ongoing Support for Your Office

Our goal is to establish a long-term billing relationship with your practice. After today’s visit, our third-party administrator, Imagine360, will follow up with your billing department to provide formal credentialing information and facilitate direct electronic billing for all future appointments.

For billing questions or to verify coverage, please contact:

• Plan Support: 866-206-3224
• Payor ID: Payer ID 48143

If you have any questions or concerns, you can reach the plan administrator, John Bialous, at jbialous@milesit.com or at 609-760-8488. We are here to help make this process as smooth and easy as possible for your practice.

Thank you for your time and attention to this matter.