Get Oifp 1 Claim Fraud Referral Form

Filling out the Oifp 1 Claim Fraud Referral Form is an important process for reporting potential insurance fraud. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately online.

Follow the steps to fill out the Oifp 1 Claim Fraud Referral Form online:

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by providing the Oifp case number, intake number, and investigator details in the designated fields at the top of the form.
3. Fill out Part I by entering the insurance company's name and address. Also, include the date reported, NAIC company number, date of loss, policy number, and claim number if available.
4. Input contact details for the individual referring the claim, including telephone number, contact person, and email address.
5. Select the type of coverage by checking the appropriate box related to health, dental, or other coverage options.
6. Next, enter the details for the insured, including their full name, address, date of birth, and Social Security or Tax Identification number.
7. Provide information about the provider involved by selecting the type of provider and indicating the specialty as applicable.
8. Specify the status of the claim, indicating whether it is pending, paid in full, denied, or paid in part, and note the amount paid if applicable.
9. If you suspect a pattern of violations, indicate yes or no, and provide details of other related claims if necessary.
10. In Part II, check any applicable provisions of the New Jersey statute that may have been violated.
11. In Part III, describe the facts and circumstances that led to the suspicion of fraud, listing any false statements made.
12. Cite any corroborating evidence, and specify any licensed professional's involvement if suspected.
13. Finally, in Part IV, certify the custodian of records by listing the documents and providing the custodian's full name and title.
14. Once you have completed all sections of the form, save your changes, download a copy for your records, and print or share the form as needed.

Take action today by completing your forms online and ensuring all necessary documents are submitted accurately.