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Download the General Complaint Form (Instructions included)
Pharmacy Timely Payment Multiple Claim Complaint FormsPharmacy Prompt Payment Form Instructions
Pharmacy Prompt Payment Complaint Form
Provider Timely Payment Multiple Claim Complaint Forms
For Electronically Filing Multiple Claim Complaints
Provider Multiple Complaint Form Part I & II
Provider Multiple Complaint Spreadsheet for Claims with Dates of Service 12/31/05 and Before
Interest Calculator for Claims with Dates of Service 12/31/05 and Before
Provider Multiple Complaint Spreadsheet for Claims with Dates of Service 01/01/06 and After
Interest Calculator for Claims with Dates of Service 01/01/2006 and After