Payor Claims Resolution Form
- Payor Claims Resolution: complete to ask the PHO for Claim Assistance.
- CPT Code Reimbursement request form: complete to ask the PHO for specific CPT code reimbursement amounts per invididual payor network.
- Change of Practice Infomation Form: complete to notify the PHO of any address changes or Additions/new practice information. Required documentation includes a new W9 for office address changes and the physician's signature/date.