- Protected Health Information Release Form (HIPPA Release Form) – authorizes ClaimLinx and other entities to discuss your medical coverage and claims on your behalf. An member over the age of 18 must fill out this form.
- Provider Information Form – so we may contact your provider(s) and send them claim filing instructions.
Fill out your name and email address below and click “Prepare Document” to get started. Once complete, these forms are automatically sent to the ClaimLinx enrollment team. If you are having trouble using the below form, download a copy and send it to email@example.com.