Get Address For Reimbursments For Hill Physicians Form

Filing for reimbursements can be straightforward when you know how to complete the Address For Reimbursements For Hill Physicians Form. This guide provides clear and supportive instructions to help you easily navigate the online process.

Follow the steps to successfully complete the reimbursement form online.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the doctor’s name in the designated field. This information is essential for referencing your vaccination provider.
3. Next, input your health plan name. This should match the plan under which you are enrolled.
4. Provide your Subscriber ID number, which can be found on your insurance card. This helps in verifying your coverage.
5. Enter your first and last name in the appropriate fields to ensure that the reimbursement goes to the correct person.
6. Fill out your street address, city, and the state (CA) to ensure accurate correspondence.
7. Complete the zip code section for precise location identification.
8. Include the date of birth for the person who received the vaccination, as this is required for processing.
9. Provide a phone number with the area code to allow for contact if there are any issues with your reimbursement.
10. Indicate where the service was performed, mentioning the retail location if applicable.
11. Attach the original receipts, ensuring that one receipt corresponds to each member claiming reimbursement.
12. Review all completed fields for accuracy. Once satisfied, save any changes made to the form.
13. Proceed to download and print a copy of the completed form for your records, and mail it to: Hill Physicians Medical Group, Flu Vaccine Reimbursement Program, P.O. Box 5080, San Ramon, CA 94583-0980.
14. Remember to allow four weeks for reimbursement processing to receive your refund.

Start completing your reimbursement documents online today for a smooth reimbursement experience.