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hi dr shito maharaj vice president and medical director here at impact health sharing today were going to discuss what you need to do to submit a medical expense form you can complete your medical expense form online by visiting impacthealthsharing.com forward slash forms then selecting medical expense form completing a medical expense form requires detailed information please provide as much information you can to ensure timely processing missing information will result in delayed processing if you are completing this form for a medical provider one of the most important things is to ask your provider for the cms 1500 also known as a hikva form or a ub04 form to submit on their behalf if your provider facility cant give you that specific form you can ask for a super bill or an itemized bill but it must contain the following information the doctors name providers billing address which is not always the same as their physical address tax id number icd-10 code also known as diagnosis
