Home | Medical Corner | Flexible Spending Accounts | Provider Corner | Business Solutions | News & Events | Contact Us
 
 
 
 
Login
At Mountain States we are on a Mission:

"To satisfy our clients needs and expectations through the development of quality plans, while delivering exceptional customer service by exceptional employees."
* Service Center

*

Find a Doctor
Click here to find a listing of PPO Network websites.

*
MSAS Medical Forms

Please click on the form type below to view.

* fill out and email to Mountain States

  • Accident Letter*
  • Dental Claim Form
  • HRA Claim Form
  • Medical Claim Form (HCFA 1500)
  • MSAS Patient Information Form
  • Other Insurance Coverage Letter*
  • Subrogation Letter*
  • Vision Claim Form

    Click here to download Adobe Acrobat Reader

    *

    Pharmacy Websites
    Click here to find a listing of Pharmacy websites.

    *
    Flexible Spending Accounts

    Please click on the form type below to view.

  • FSA Claim Form
  • FSA Expense Estimation Worksheet
  • FSA Eligible OTC List
  • Letter of Medical Necessity
  • FSA Receipt For Independent Day Care Provider

    Click here to download Adobe Acrobat Reader

    *


    MyMSAS online may allow clients to view:
  • Claims Information
  • Coverage Verification
  • Flexible Spending Account Balances

    • MyMSAS Online Registration Instructions

    *

    Benny Card


    		  

        © 2003 Mountain States Administrative Services