While we provide you with a Universal Claim Form, your insurer will probably require that you submit your claim form along with their completed claim form. Insurers often request “NDC Numbers” for medications. You can find the NDC numbers for your compounded medications on the right side table near the middle of our claim form.
Medco Claim Form – Medco.pdf
IBM-Medco Claim Form – IBM-Medco.pdf
United Health Care Claim Form – United Healthcare.pdf