Claims Department
Claims FAQs
What are the hours of operation for the Claims Department?
Monday- Friday, 9:00 am-5:30 pm (CST). We are available via phone and email.
The Claims Dept. does not use chat.
How can I check the status of my claim?
- Please contact us via phone or email for status updates during our business hours.
- Effective November 28, 2022, status updates emails will be sent to members to view EOBs on their portal under Forms, Links, and Documents. This includes both member submission claims and providers.
What does it mean if my claim is pending?
- The Claims Department only pends member claims. Provider claims are finalized with a detailed reason on the EOB why the claims were denied. If your claim is pending, we like to give members time to collect/gather all the information needed to finalize the claim.
- The Claims Department completes three outreaches to contact each member for additional information.
– First Outreach via email
-Second Outreach via phone (will leave voice mail, if necessary)
-Third Outreach – a letter is sent to the address on file if we are unable to contact you within 5 business days.
Why do I need a receipt to be reimbursed?
Triada requires proof that payment was made to your provider to reimburse your GAP benefits. GAP benefits are to support medical costs.
What can I do if my provider refuses to submit a claim to Triada?
We will work with you! Contact us if you have a significant charge, and we can discuss our partial payment plan.
Can my provider bill Triada directly?
Please reference Claims Submission Guidelines.
How will I be reimbursed?
We can reimburse you via paper check or direct deposit.
Paper Checks
The standard timeframe is 7-10 business days for standard mail
Direct Deposit
The standard timeframe is 3-5 business days.
What is the turnaround on claims?
Five business days (This does not include the timeframe for a payment to be issued.)
Member Submissions:
1. Portal (Currently not applicable for CCPOA members, please submit documents via mail, email or fax)
Upload all required documents
– Itemized bill
– Primary EOB
– Receipt (Any form of proof payment)
2. Mail
Mail all required documents to 15814 Champion Forest Dr #135 Houston, TX 77379
– Claim Form
– Itemized Bill
– Primary EOB
– Receipt (Any form of proof payment)
3. Email all required documents to claims@triada.com
– Claim Form
– Itemized Bill
– Primary EOB
– Receipt (Any form of proof payment)
4. Fax all required documents to 281-343-3613.
– Claim Form
– Itemized Bill
– Primary EOB
– Receipt (Any form of proof payment)
Provider Submissions:
Mail all required documents to
15814 Champion Forest Dr #135 Houston, TX 77379
Claim Form (UB-04 & HCFA-1500)
Copy of the member’s primary/secondary/ tertiary EOP/ERA
Fax all required documents to 281-343-3613.
Claim Form (UB-04 & HCFA-1500)
Copy of the member’s primary/secondary/ tertiary EOP/ERA
Email all required documents to claims@triada.com
Claim Form (UB-04 & HCFA-1500)
Copy of the member’s primary/secondary/ tertiary EOP/ERA