Submit a Payer Issue to the Payer Relations Committee


Payer Question Form - March - May 2024

Payer Question Form for Payer Representatives

Payer Relations Committee Meeting


Who is the question for (Payer)?: *
Aetna
Wellpoint (Amerigroup)
Health Partners
Iowa Medicaid (IME)
Iowa Total Care
Medica
Midlands Choice
Molina
United Healthcare
Wellmark
WPS/Medicare
Other (provide specific payer info below)
Provide Payer info if "Other" checked above:
Question:
Submitted by (Your Name): *
Email Address: *
Organization: *
Examples of Issue (please no PHI and de-identify any examples)::
Attach Example list of Issue (NO PHI PLEASE):
(Valid File Types: bmp,csv,doc,docx,eps,gif,jpeg,jpg,mfp,pdf,png,ppt,pptx,rft,swf,tif,txt,xls,xlsx | Maximum File Size : 5.0 MB)



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