MIF Claim Submission Guidance - Provider Claims - NY 2025

1. Click ‘Get Form’ to open the MIF Claim Submission Guidance in the editor.
2. Begin by entering the 'Name of Enrollee' and 'Enrollee ID#' in the designated fields. Ensure accuracy as this information is crucial for processing your claim.
3. In the 'Purpose of Travel' section, provide a brief description along with the names of any individuals who traveled with the enrollee.
4. Check all applicable boxes regarding travel details, including 'Dates of Travel' and 'Type of Transportation'. Be specific about your mode of transport, such as car, train, or airplane.
5. If overnight accommodations were necessary, list those details in the corresponding section. Include any fuel costs associated with your trip in the designated area.
6. Document any additional expenses related to your travel and ensure you calculate the total cost accurately at the end of the form.
7. Finally, certify that all information provided is accurate by signing and dating where indicated. Attach all supporting documents before submission.

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