Secondary Insurance Request

Click here to view a sample of a patient bill.

If you have difficulty understanding English, we offer language assistance and interpretation services at no cost to you. For help, please call 1-844-359-5381. If you have hearing or speech loss and use Telecommunications Relay Services (TRS) or a Text Telephone (TTY), dial 711 to connect with a TRS operator.

Access our non-discrimination notice. Sign Authorization Form to Release your Protected Health Information (PHI) . Sign a Medicare Appointment of Representative form. Access the Patients Rights and Responsibilities.

Under the CareCentrix Utilization Management (UM) Program: 1) UM decision making is based on appropriateness of care & service and existence of coverage; 2) CareCentrix does not specifically reward practitioners or other individuals for issuing denials of coverage or service care; and 3) Financial incentives for UM decision makers do not encourage decisions that result in under-utilization.

CareCentrix maintains a drug-free workplace.

Secondary Insurance Request

Medicare/Tricare Request