Office of Insurance and Safety Fire CommissionerRalph T. Hudgens
Commissioner
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Managed Care Forms

ATTENTION: We have NEW IMPORTANT payment procedures. Please view them here.

Form #: GID-258-LH (same as Provider Instructions) This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2011
Title: Provider Complaint Form
Please use this Provider Complaint Form when Mailing your Insurance issues into the Department.

5/16/2012 4:41:06 PM
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