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Get Ms Magnolia Health Provider Claim Dispute Form
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How to fill out the MS Magnolia Health Provider Claim Dispute Form online
Filling out the MS Magnolia Health Provider Claim Dispute Form online is an important step in disputing a claim decision made by Magnolia Health Plan. This guide will provide you with clear and detailed instructions to ensure you complete the form accurately and efficiently.
Follow the steps to successfully complete the claim dispute form.
- Press the ‘Get Form’ button to access the MS Magnolia Health Provider Claim Dispute Form and open it in your preferred document editor.
- Begin by filling in the required information in the designated fields, which include your provider name, provider tax ID number, and the dates of service relevant to your claim.
- Locate and enter the control number found under the patient name on the explanation of payment (EOP) document.
- Input the member name and their corresponding member ID number (RID number) to ensure correct identification.
- Select the appropriate reason for dispute by checking the relevant box. Options include issues related to authorization, timely filing, or payment errors. If 'other' is selected, provide a clear description in the space provided.
- Fill in the date of request and include the name of the person requesting the dispute, along with their contact phone number.
- Attach a copy of the EOP or EOPs along with the original request for reconsideration, ensuring the claims to be adjusted are clearly circled.
- Review the completed form for accuracy. Once satisfied with the information inputted, save changes to your document, and prepare to download, print, or share the form as needed.
Complete your claim dispute form online today to facilitate prompt resolution.
For inquiries related to Ambetter Magnolia Health, you can call 1-877-687-1180. Their customer service team can help you navigate your health insurance options and provide pertinent information for managing your coverage. To resolve any claims disputes, utilizing the MS Magnolia Health Provider Claim Dispute Form is recommended.
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