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Get NY General Reimbursement Form 2022-2024
4wRKMedicalGENERAL REIMBURSEMENT FORM USE FOR:TEIndemnity Fund Providers ' services Respite care Office visit copays, coinsurance and deductibles SuppliesEnrollee Name Enrollee MIF ID #NYSInstructions.
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COPAY FAQ
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Mail: MIF c/o PCG, PO Box 7315 Albany, NY 12224. Fax: 518-344-1293.
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Below are claim submission guidelines for providers submitting claims to the Medical Indemnity Fund (MIF).
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With an indemnity plan (sometimes called fee-for-service), you can use any medical provider (such as a doctor and hospital). You or the provider sends the bill to the insurance company, which pays part of it. Usually, you have a deductible—such as $200—to pay each year before the insurer starts paying.
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Please note that all completed claims are required to be received by the MIF within 90 days from the date services are rendered or purchased.
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Mail: MIF c/o PCG, PO Box 7315 Albany, NY 12224. Fax: 518-344-1293.
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The MIF was designed to provide a funding source for future health care costs of "qualified plaintiffs," as defined by law, who suffered birth-related neurological injuries due to medical malpractice during a delivery admission.
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If you have any questions about obtaining authorizations or submitting claims, please contact us: NY_DOH_MIF@pcgus.com or call 1-855-NYMIF33 (1-855-696-4333).
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The MIF was designed to provide a funding source for future health care costs of "qualified plaintiffs," as defined by law, who suffered birth-related neurological injuries due to medical malpractice during a delivery admission.
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