Veterans referred by the VA must also submit a Military History Form
Simply click on the links below:
To download and print paperwork please scroll down and select from files below.
Insurance Billing Forms
Medicare Form 1490-S To Obtain Medicare Denial Letter - SPANISH (pdf)
DownloadMedicare Form 1490-S To Obtain Medicare Denial Letter - ENGLISH (pdf)
DownloadOut-of-Network Notice (docx)
DownloadAetna - Medicare Medical Claim Reimbursement Instructions (pdf)
DownloadNetwork Gap Exceptions Can Help Get the Care You Need (pdf)
DownloadFee schedule and other misc. forms
2021 - 2022 Fee Schedule (docx)
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