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Download the General Complaint Form (Instructions included)
Provider Timely Payment Multiple Claim Complaint Forms
For Electronically Filing Multiple Claim Complaints
Provider Multiple Complaint Form Part I & II
Provider Multiple Complaint Spreadsheet for Claims with Dates of Service 12/31/05 and Before
Interest Calculator for Claims with Dates of Service 12/31/05 and Before
Provider Multiple Complaint Spreadsheet for Claims with Dates of Service 01/01/06 and After
Interest Calculator for Claims with Dates of Service 01/01/2006 and After