Submission Instructions – Use this form to submit multiple claim adjustment requests. Grid can contain up to fifty (50) claims with no attachments. This form is used to submit multiple claim adjustments. Once submitted, you will receive:
- An immediate confirmation email
- An acknowledgement email with a reference number and a copy of the original grid within 48 hours
- A response to your grid within 30 days from the acknowledgement email date
Helpful Hint: if the description of issue applies to multiple claims, you can copy and paste to help speed up entry time. Fields indicated with a * are required fields.