Penn Treaty Network America Insurance Company (In Rehabilitation) / American Network Insurance Company (In Rehabilitation) fax number

Fax destination details

Department

Claims Department

Purpose

Submitting initial long-term care insurance claim documents; faxing facility certification for initial claim to Penn Treaty Claims Department.

Form

FCC IR 12/09 — Facility Certification of Care for Initial Claim

Address

Attn: Claims Department, P.O. Box 7066, Allentown, PA 18105-7066

Voice phone

1-800-362-0700

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Fill out the facility and resident information as required (facility name, address, provider details, resident information, etc.), attach required documents (physician orders, nursing assessments, state licenses, W-9, resident agreement, itemized bill, Medicare EOBs if applicable), and fax to 610-965-6962.

Official form instructions are published as a downloadable file on the organization's website.