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Customer Tools - Claims Resolutions

Are you having trouble getting an insurance claim paid properly? No problem!

Just provide one of the following:

  • input the information below and submit or
  • fax (229-248-0970) Explanation of Benefits (EOB) from the insurance company with your contact information.

We will contact you once the claim is resolved or if other information is needed.

* Indicates required field.

*First Name:

*Last Name:

*Email:

*Phone:

() -

*Date of Birth
(MM/DD/YYYY):

/ /

Member Id#:

Date of Service
(MM/DD/YYYY):

/ /

Provider:

Amount:

Additional Comments:

 







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