PROVIDER PORTAL / REFUND ADJUSTMENT LIST

Refund Adjustment List

Please use the form below to communicate with FMBS a list of refund payments sent out on behalf of your practice so proper accounting corrections can be made on the FMBS account. Please note, you will see a refund adjustment to reflect the information on future reports.

    Refund Adjustment List
    *A copy of this completed form will be sent to your provided Sender Email address.


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