New Provider Appeal Forms
Posted on March 11, 2010
Please replace any old versions of the Provider Appeal form with the new version. There are also 2 newly created forms for On-Time Corrected claims (corrected claims submitted within 180 days of the date of service) and a Coordination of Benefits (COB) form for claims issues involving other insurance (worker’s compensation, motor vehicle, etc.)
provider-appeal-form ottcform2010 cobform2010
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