Shiel Medical Laboratory - Submit Billing Information

Submit Billing Information

If you would like us to file with your primary insurance company, complete all patient and policy holder information below and click on the SUBMIT button below to send.
Information from your invoice: (*Required Fields)
*Date of Service
*Account Number
*Patient Name
Information from your Insurance Card:
*Primary Insurance Company
*Claims Office Address
*Policy/Member ID#
*Group Number
Employer
*Name of Insured
Patients Relationship to Insured: (i.e. spouse, child, self)
Secondary Insurance
Insurance Company
Claims Office Address
Policy/Member ID#
Group Number
Employer
Name of Insured
Patients Relationship to Insured: (i.e. spouse, child, self)
Comments or questions concerning your bill?
If we need to contact you, please provide us with the following:
Phone Number
Email Address
Contact Name
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