Provider Information Requests

The below online request forms are provided to help expedite your requests and accurately answer your questions. Please complete one of the below online forms and click on the "Submit" button to send it to a Health Tradition representative. NOTE: Form response times may take up to 21 days. Please use the Provider IVR for the quickest response times.

Request an Explanation of Payment (EOP)

If you would like duplicate copies of an Explanation of Payment (EOP), please complete the EOP Request form below and click on the "Submit" button. NOTE: If you receive an electronic EOP, we are unable to provide specific details. You will need to contact your IT department for that information.

Patient/Member Name*

Patient/Member ID*

Patient/Member Date of Birth*

Clinic or Provider*

Date(s) of Service*

Billed Amount of Service*

NPI or TIN*

Email*

Fax*

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Provider General Information Requests

For General Provider Inquiries please complete the form below and click on the "Submit" button. Please note it may take up to 21 days for a response to this inquiry form.

Patient/Member Name*

Patient/Member ID*

Patient/Member Date of Birth*

Callback Name*

Callback Phone #*

Email*

Service Date(s)*

Clinic or Provider*

Billed Amount*

Claim # (if applicable)

NPI or TIN*

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