How to Correct a Rejected Claim 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Requesting Organization Information' section. Ensure you provide the organization name, today's date, and the requesting person's details including their title and contact numbers.
3. In the 'Participant Information' section, accurately enter the participant's name, identification number, and date of birth. This information is crucial for processing your claim.
4. Next, complete the 'Trip Information' section. Specify appointment times and whether it's a one-way or round trip. If correcting a previous trip, include the RTN from that trip.
5. Fill in the 'Origin – Destination Information' with detailed addresses and contact numbers for both pick-up and drop-off locations.
6. Answer all questions regarding transportation needs and conditions thoroughly to ensure clarity on service requirements.
7. Finally, review your entries for accuracy before signing in the 'Agreement and Signature' section. Your signature certifies that all provided information is true.

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