Superbill Inquiry / Update / Correction

In the event you need to make a correction, update or inquiry regarding a superbill you have submitted, please use the form below.

**Please note this form should ONLY be used for minor corrections/updates and not to request a claim to be newly created or submitted. In those cases, please visit

Sender Email*:
*A copy of this completed form will be sent to your provided Sender Email address.
Superbill Inquiry / Update / Correction
Date: Provider Name:
Patient Name: Patient DOB:
Correction / Update / Inquiry: