Gone are the days of tedious paperwork and manual filing. With technology transforming nearly every aspect of our lives, it’s understandable to want an easier solution when it comes to filling out forms. That’s why the Hipp Fax form exists—it's a revolutionary way to digitally complete records requests from anywhere in just minutes! Securely send important patient information without ever having to worry about keeping physical evidence organized or losing vital data. Whether you're stuck in your office or need medical release forms for vacation trips, discover how HippFax can streamline your workflow by making paper documents obsolete!
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.