Insurance Request Form

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.

Article Details

Article ID:
8
Category:
Date added:
2016-08-10 14:45:23
Rating (Votes):
(362)

Related articles