Humana Hmo Claim Resolution Form - Silverbacktpa
ADVERTISEMENT
1HUMANA HMO CLAIM RESOLUTION FORM - SILVERBACKTPA
Office Information
Practice Name:
Did you call
SilverbackTPA-
Your Name:
Claims Dept?
877-569-6149
Phone Number:
Date:
Date called:
Person you spoke
with at the
SilverbackTPA-
Claims Dept:
Did you verify
SilverbackTPA –
insurance?
Claims Dept call
results:
Humana
Submit
Total
ID
Patient Name
DOB
DOS
Date
Charges
Notes (Claim #, describe scenario)
Was claim paid according to contract? Yes
No
If No what is your current rate _________
Please attach examples when submitting this form. ( EOB’s, Check copies, etc)
SilverbackTPA-Claims Dept Resolution:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business