INSURER FILING GUIDE

Asuris Northwest Health

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	DIRECT MEMBER REIMBURSEMENT FORM Number: PD017 Revision: 2015-11 (printed in month/year order) Open the insurer form
Portal upload	NO
Portal path	NO: current member reimbursement form publishes only a nonportal submission route
Mail address	Asuris Northwest Health, PO Box 1106, Lewiston, Idaho 83501
Fax	Not published by the insurer
Attachments	Provider name and address; National Provider Identifier; diagnosis and procedure codes; date of service; itemized charges; original receipts; cash register receipts are not accepted
Deadline	1 year after date of service
Outcome and status	Sign in and select Claims on the member account page
Processing time	30 days after receipt; may extend 15 days when the stated conditions apply
Caveats	A separate form is required for each family member, pharmacy, or provider. Medicare Advantage and Medicaid are outside this read. Out-of-network coverage depends on the member contract.

STEP BY STEP

Read date: 10-09-2026

Confirm that the member contract has an out-of-network benefit and that the claim is within its filing limit. The published individual policy gives one year after the date of service. https://apis.asuris.com/v1/publicdocuments/sales/individual/productId/WMA17078/docType/OM/pdf?brand=asur
Download and complete the DIRECT MEMBER REIMBURSEMENT FORM, PD017. Use a separate form for each family member and provider, and place the member ID number on each page. https://beonbrand.getbynder.com/asset/9c0b34c9-fcca-4641-bef6-04219be51ca5/Member-Reimbursement-Claim-Form.pdf
Attach the original receipt or itemized bill. It must show the provider name and address, National Provider Identifier, diagnosis and procedure codes, date of service, and itemized charges. A cash register receipt is not accepted. https://beonbrand.getbynder.com/asset/9c0b34c9-fcca-4641-bef6-04219be51ca5/Member-Reimbursement-Claim-Form.pdf
Have the subscriber or patient sign and date the form. https://beonbrand.getbynder.com/asset/9c0b34c9-fcca-4641-bef6-04219be51ca5/Member-Reimbursement-Claim-Form.pdf
NO PORTAL UPLOAD: the current form publishes only a nonportal route. No portal or app upload step is published. https://beonbrand.getbynder.com/asset/9c0b34c9-fcca-4641-bef6-04219be51ca5/Member-Reimbursement-Claim-Form.pdf
After processing, sign in and select Claims on the member account page to review claim history. https://www.asuris.com/member/understanding-health-insurance/get-the-most-from-your-coverage

Portal upload: NO
Portal: Asuris member account
Portal path: NO: current member reimbursement form publishes only a nonportal submission route
Mail address: Asuris Northwest Health, PO Box 1106, Lewiston, Idaho 83501
Fax: NOT PUBLISHED
Attach: provider name and address; National Provider Identifier; diagnosis and procedure codes; date of service; itemized charges; original receipts; cash register receipts are not accepted
File types: NOT PUBLISHED
File size limit: NOT PUBLISHED
Maximum files: NOT PUBLISHED
One file or separate files: NOT PUBLISHED
Confirmation: NOT PUBLISHED
Status check: Sign in and select Claims on the member account page
Processing time: 30 days after receipt; may extend 15 days when the stated conditions apply
Member deadline: 1 year after date of service
Deadline basis: Published individual plan policy; group and self-funded plan documents may differ
Mental health route: NOT PUBLISHED: no separate behavioral claim route found in public sources

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://beonbrand.getbynder.com/asset/9c0b34c9-fcca-4641-bef6-04219be51ca5/Member-Reimbursement-Claim-Form.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.