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Managed Care Forms

ATTENTION: We have NEW IMPORTANT payment procedures. Please view them here.

Form #GID-258-LH (same as Provider Instructions) This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2017
Title: Provider Complaint Form
Please use this Provider Complaint Form when Mailing your Insurance provider issues into the Department.

If you are a Consumer, please do not use the Provider Complaint Form on consumer issues. Instead, you should use the Consumer Complaint Form GID-CS-CF-1 located under Quick Links on our Home Page of this website.
PID:402-SID:1561-FN:GID-258-LH.pdf

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