Report a Payor

If you believe you are the target of unfair payment practices and negligent denial tactics, we encourage you to raise your voice by reporting your case.

If you are a Healthcare Provider and would like further claims assistance and representation, we encourage you to visit The Reimbursement Advocacy Firm and contact us with your needs.

Provider Member Complaint Form
Type of Insurance
Is this an employer or group plan (ERISA)?

DETAILS OF COMPLAINT

Please provide more information about the incident being reported.

Has a the patient considered filing a complaint with the state?
If not, will the patient consider filing a complaint?
Have YOU filed a complaint with the State?
Please check the description that resembles your issue
IMPORTANT: Please note that this submission form is not protected by security mechanisms. Therefore, please refrain from including sensitive information and the unsecured transfer of PHI, which could constitute a HIPAA violation.

PROVIDER CONTACT INFORMATION

Please provide more information about the healthcare provider who provided services in this incident.

Name of contact from provider
Name of contact from provider
First
Last