Patient Reimbursement Request Information

Patient Information and Instructions for Requesting Reimbursement


  • All services must be paid to provider in full prior to requesting reimbursement. MHC does not accept unpaid bills or statements as an acceptable form of request for reimbursement.
  • All claims that have been partially paid by another primary insurance must include an Explanation of Benefits (EOB) from your primary insurance.
  • All reimbursement requests must be received by MHC within 1 year of the service date.
  • Hospital ancillary charges, laboratory services, and drug testing are not covered by your mental health benefits.
  • Reimbursements will come directly from your union. Please allow approximately 6-8 weeks for processing/payment.
  • To request a referral to a network provider, please contact a care manager at MHC.
  • Your treating provider should include the following items on your itemized receipt:
    • Treating provider’s name including license/degree, address, and NPI#
    • Patient’s name and date of birth
    • Date(s) of service
    • ICD-10 Diagnosis Code(s)
    • Type of service (CPT Procedure Code)
    • Charge for service
  • Submit the itemized receipt/claim(s) to MHC.


Submit receipts to:


1501 Lower State Road

Bldg D, Suite 200

North Wales, PA 19454

Or fax to 215-343-8983