K12 Claims Procedure
School's Responsibility
- Complete Part 1 (school’s portion) of the claim form for all claims, signature is required.
- Give the claim form to the parent for completion of the parent’s portion (Part 2) for all claims.
- The claim form must be completed in full and returned to the claims admin at the address on the claim form.
- The claim form must be filed within 90 days from the date of injury (immediately after injury date, if possible).
Parent's Responsibility
- Complete the claimant’s section (Part 2) of the claim form in full for all claims.
- Attach all itemized medical bills that have been incurred for all claims.
- Attach all explanations of benefits (EOB) or notices of denial from the primary insurance carrier for All Sports claims.
- Make sure the physicians and other providers of service send all subsequent itemized bills to the address on the claim form.
Other Important Information
- Providers DO NOT need to send an additional CLAIM FORM with subsequent bills as long as we have a claim form on file. The bills must be submitted to the address on the claim form along with the social security number and school district name.
- BILLS CANNOT BE PROCESSED UNTIL THE CLAIM FORM IS ACCURATE AND COMPLETE.
- Mail claims and Correspondence to:
Health Special Risk
HSR Plaza II
4100 Medical Parkway
Carrollton, TX 75007
Phone: 888-765-7223
Fax: 972-512-5820
Email: claims@hrsi.com