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Insurance Request Form

Solution

If you need to submit a request to Add, Update, or Deactivate an Insurance Provider, please complete the attached form, provide a copy of the insurace card front and back, complete proof of eligibility verification, include the encounter number, and submit it to Janice Jones at jonesjl01@etsu.edu. Do not attach any PHI to a Help Desk Ticket.

Attachments:
Insurance-Request.pdf Insurance-Request.pdf

 
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Article ID: 8
Category: Knowledgebase
Date added: 2016-08-10 13:45:23
Views: 236
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