PROVIDER PORTAL / REQUEST TO CORRECT

Request to correct an already PROCESSED claim

Please use this option to request a correction to a claim that has been processed by insurance. The original claim number from the processed EOB is required.





    *A copy of this completed form will be sent to your provided Sender Email address.
    Request to correct an already PROCESSED claim
     
    Please :
    No file chosen, yet.
    Date of Service Change:
    Change FROM Date: Change TO Date:
    Change CPT Coding:
    Change FROM Coding: Change TO Coding:
    ADD Coding: Provide the DX for ADDed CPT:
    Change Diagnosis Coding:
    Change FROM Coding: Change TO Coding:
    Notes:
    I have read and understand the disclaimer. View Disclaimer

    Favored Medical Billing Logo

    Are you a medical provider interested in medical billing and coding services?
    Get started now!

    General Inquiries

    Please send us a brief message
    and we will follow up with you shortly!
    Stay Connected