Claim inquiry form 2026

1. Click ‘Get Form’ to open the claim inquiry form in the editor.
2. Select the type of inquiry by checking either 'Amount of Payment Questioned' or 'Rejection Questioned'. This helps categorize your request for faster processing.
3. Fill in the Member’s Plan section by selecting from options like Personal Choice® PPO, KHPE HMO, or others. Ensure accuracy to avoid delays.
4. Complete the Practice Name and Provider Number fields. This information identifies your practice and facilitates communication.
5. Enter your contact details including Street Address, City, State, Zip, and Telephone Number. This ensures we can reach you if needed.
6. Provide Member Name, Patient’s Name, Member ID, Check Number, Claim Number, Date of Check or Explanation, Date of Service, and Place of Service. These details are crucial for processing your inquiry.
7. In the Detailed Inquiry Reason section, clearly explain your issue. The more specific you are, the better we can assist you.
8. Once completed, download and print the form along with any supporting documentation before mailing it to IBC Claims Inquiry at the provided address.

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