Follow the steps to fill out the HIPP Fax Cover Sheet accurately.

1. Click the ‘Get Form’ button to obtain the HIPP Fax Cover Sheet and open it in your preferred editor.
2. In the 'To:' field, enter 'EBPA Reimbursement Department' as the recipient of the fax.
3. Fill in the 'Participant’s Name' section with the name of the individual submitting the claim.
4. Indicate the total number of pages being sent, including the cover sheet, in the 'Number of pages' field.
5. Add the correct fax number, which is '1-603-773-4415', in the 'FAX #' section.
6. Write the 'Employer Name' in the designated area to identify where the claim is originating from.
7. Enter the current date in the 'DATE' field to reflect when the fax is sent.
8. In the 'Participant’s Contact Information' section, provide either a telephone number or email address for follow-up communication.
9. Check the appropriate box under 'Important Claim/Substantiation Submission Information' to indicate whether you are submitting a new claim or documentation.
10. If submitting a new claim, ensure you have completed the 'FSA Reimbursement Claim Form' as required.
11. If submitting supporting documentation, remember to include any necessary letters or responses along with this fax cover sheet.
12. In the 'MESSAGE' section, you may include any additional information relevant to your submission.
13. Once all fields are filled out correctly, save your changes and then download, print, or share the completed HIPP Fax Cover Sheet as needed.

Complete your HIPP Fax Cover Sheet online today to ensure your reimbursement claims are processed efficiently.