What does an itemized medical invoice need to include? – Sidecar Health Access Plan

For us to process your expense, you need to send us an itemized medical invoice – otherwise known as a “superbill” or “medical bill.”

For provider bills:

The itemized medical invoice must include the following information:

Patient's name
Provider’s name and National Provider Identifier (NPI) number
Date(s) of service
Amount charged by the provider for each service
CPT codes for the services
Reason for the services (including all ICD-10 diagnosis codes)

EXAMPLE

For pharmacy bills:

Below is an example of the correct receipt to include on your expense. In most cases it is stapled to or included in your Rx bag. It will include all the following information required to process your claim:

National Drug Code (NDC)
Patient’s name
Prescriber’s name
Pharmacy name and address
Fill date
Amount charged per prescription
Drug name, form, strength, and dosage

EXAMPLE

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