Use this secure form to send us information when inquiring about a patient or claim.
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Participating Handbook
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Fee Filing
Abbreviated Fee Filing
W-9
Change of Address
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Contact Customer Service
Customer Service
Customer Service Fax
800-452-9310
973-285-4141
Mailing Address
Street Address
P.O. Box 222
Parsippany, NJ 07054-0222
1639 Route 10
Parsippany, NJ 07054-0222
Note: Items in bold are required fields.
1. What is it you are inquiring about?
2. Patient Information
First Name:
Last Name:
Date of Birth:
(mm/dd/yy)
3. Subscriber Information
First Name:
Last Name:
Social Security #:
Employer:
Group Number:
4. Contact Information
E-mail:
Daytime Phone #:
Evening Phone #:
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