Insurance Information Update – Superb Diagnostics LLC

Action Required within 20 Days: The insurance information on file is inactive. We cannot submit your claim until we receive updated information. Failure to respond will result in the balance being reclassified as self-pay.

Claim Information

Claim Number *

Date of Service *

Patient Information

First Name *

Last Name *

Date of Birth *

Phone Number

Insurance Holder Information

Insured First Name *

Insured Last Name *

Insured Date of Birth

Relationship to Patient *

Insurance Plan / Payer Name *

Member ID *

Document Uploads

Insurance Card — Front *

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Tap to upload or photograph

Front of insurance card

Insurance Card — Back *

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Tap to upload or photograph

Back of insurance card

Photo ID (Driver's License or Government ID)

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Tap to upload or photograph

Front of government-issued photo ID

Your information is transmitted securely. Questions? Call 201-708-8361 or email billing@superbdx.com, Monday through Friday, 8:00 AM to 5:00 PM Eastern Time.

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Information Received

Thank you. We have received your updated insurance information and will begin processing your claim shortly.

Questions? Call 201-708-8361 or email billing@superbdx.com.