Submit a Payer Issue to the IMGMA Payer Relations Committee


Submit a Payer Issue to the IMGMA Payer Relations Committee

Complete the form below and your question/issue will be submitted to the Payer Relations Committee

Please be sure we have your phone number and email address so that someone from the committee can reach out to you for questions or clarification.

NOTE:  Please work with your individual Payer Account Representative before submitting an issue to IMGMA

Find an Payer Relations Committee  member  by clicking on the link below:

 

IMGMA Payer Relations COMMITTEE MEMBERS

 

 


Please enter your First & Last Name::
Your Email::
The best phone number to reach you at::
Name of the payer that you have a question for::
Enter your Question/Issue in the space provided below (please do not send any PHI)::
Please briefly describe steps that you have already taken in an attempt to resolve this issue::
Date issue submitted to payer::
Date of last communication with payer::
OPTIONAL: Claim Number (Please no PHI - this number is unique to the payer to expedite tracking the issue)::
Name of your Organization::




Thank you for submitting your question/issue.  
You will be contacted soon.