Hipp Fax Form PDF Details

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!

QuestionAnswer
Form NameHipp Fax Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshipp form get, hipp form pdf, hipp fax cover page, printable fax cover sheet with hippa

Form Preview Example

HIPP Fax Cover Page

Use this cover page when faxing things to the Health Insurance Premium Payment program (HIPP).

Fax toll-free to HIPP: 1-866-409-1188

1.Fill out the following (please print):

Total pages in fax (include cover page):_____________________

Medicaid case number: __________________________________

Your name:___________________________________________

Phone: (

)

 

 

 

E-mail:_______________________________________________

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.