Please remember to use the most current request forms available on our website. Provider request forms are available in the Forms section of the Provider Resources menu on the Neighborhood website. The following forms are “writeable,” so they can be typed online, then saved/printed and submitted to Neighborhood by mail or email (depending on the request):
- Corrected (Replacement)/Voided Claim Request Form
- Claim Reconsideration Request Form
- Provider Claim Dispute & Provider-initiated Appeal Form
Please note that outdated forms will be returned to the sender for correction.
For help deciding which form to use, the Claim Form Finder, located in the Forms section of the Provider Resources menu on the Neighborhood website can help to determine which form must be completed and submitted to Neighborhood, along with additional information related to the submission of each form.