Upload Claims or Reports
Secure Claim File Submission
Please use the form below to securely upload claim files or reports. While we prefer submissions in the HCFA 1500 format, we will accept claims in any format, provided they include the following essential information:
- Patient Name
- Patient Date of Birth
- Date of Service
- CPT Codes for Services Rendered
- Provider or Facility Information
- Payment Address
Thank you for ensuring the accuracy and completeness of your submission.
Upload Claims or Reports
Secure Claim File Submission
Please use the form below to securely upload claim files or reports. While we prefer submissions in the HCFA 1500 format, we will accept claims in any format, provided they include the following essential information:
- Patient Name
- Patient Date of Birth
- Date of Service
- CPT Codes for Services Rendered
- Provider or Facility Information
- Payment Address
Thank you for ensuring the accuracy and completeness of your submission.
Upload Claims or Reports
Secure Claim File Submission
Please use the form below to securely upload claim files or reports. While we prefer submissions in the HCFA 1500 format, we will accept claims in any format, provided they include the following essential information:
- Patient Name
- Patient Date of Birth
- Date of Service
- CPT Codes for Services Rendered
- Provider or Facility Information
- Payment Address
Thank you for ensuring the accuracy and completeness of your submission.