In navigating the intricacies of the Health Insurance Premium Payment (HIPP) program, individuals find the HIPP Fax Form to be a critical tool. This form serves as the exclusive cover page when submitting documents via fax to the HIPP program, ensuring that all submissions are correctly routed and promptly attended to. Among the essential details required on this form are the total number of pages being faxed, including the cover page itself, the Medicaid case number, and the sender's contact information, which encompasses their name, phone number, and email address. Additionally, the form prompts the sender to specify the nature of the documents enclosed—ranging from proof of premium payments, rate sheets, summaries or explanations of benefits, copies of insurance cards, among others. This process is designed to be user-friendly and efficient, stipulating a review period of only two workdays. This document thereby plays a pivotal role in streamlining communication between Medicaid recipients and the HIPP program, facilitating a smoother management of insurance premium reimbursements.
| Question | Answer |
|---|---|
| Form Name | Hipp Fax Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | hipp form get, hipp form pdf, hipp fax cover page, printable fax cover sheet with hippa |
HIPP Fax Cover Page
Use this cover page when faxing things to the Health Insurance Premium Payment program (HIPP).
Fax
1.Fill out the following (please print):
•Total pages in fax (include cover page):_____________________
•Medicaid case number: __________________________________
•Your name:___________________________________________
• Phone: ( |
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2.Circle what you are faxing to HIPP:
•Proof of premium payment for the month of __________________
•Rate sheet
•Summary of benefits
•Explanation of benefits (EOB)
•Copy of insurance card
•Other:_________________________________________________
Allow 2 work days for us to review the fax.