Providers
Providers, click here for prior authorizations, eiligibility status, and claim submission information.
BeniComp IncentiCare (Self-Funded Groups)
- Form W-9 - Request for Taxpayer Identification Number and Certification
- Transparency in Coverage (Machine Readable Files)
- Subrogation Questionnaire
BeniComp Select (Executive Medical Reimbursement)
- BeniComp Select Executive Medical Reimbursement - Online Application
- BeniComp Select Executive Medical Reimbursement - Submit a Claim
- BeniComp Select Executive Medical Reimbursement - Support Form