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Provider Request for Information

The Provider Services CARE Unit is here to handle those inquiries that you are unable to resolve through Pres Online, IVR, Navimedix or Healthcare Extranet.

Please complete the following information so that we can assist you with your inquiry.

Provider Request for Information

Provider Name*:
National Provider Identifier Number (NPI)*:
Contact Name*:
Contact Phone*:
E-mail Address*:
Is this regarding a specific member, claim, or benefit? Yes
No
Member Name*:
Presbyterian Member # or SSN*:
Presbyterian Claim Number*:
Presbyterian Date of Service*:
Billed Amount*:
Reason for Inquiry*:
Attach Supporting Documentation:

File 1:

File 2:

File 3: