Notification Submission	Help Printer Friendly Page

! Currently, online notification submission is only available for Physicians, Hospitals and Skilled Nursing Facilities. All other service types should submit notifications by phone by calling 1-877-842-3210 and choosing option 3. Alternatively, notifications can be submitted via fax at 1-866-756-9733 for commercial enrollees and 1-800-676-4798 for SecureHorizons and Medicare enrollees. We apologize for any inconvenience this causes you.

Note: Submit radiology notifications via Radiology Notification Submission & Status

Notification Type

Select a Notification Type Inpatient/Outpatient Facility Outpatient Other/Office/DME/HHC

Admitting/Attending Physician Search

Admitting/Attending Physician       Facility
*Corporate Tax ID Owner:		Select a Corporate Tax ID Owner PHYSICIAN SALLY
*Physician/Provider Tax ID:		Select a Tax ID 721356674
*Physician/Provider Name:		Select a Provider SALLY PHYSICIAN, MD
*Physician/Provider Address:		Select an Address 130 Main Road, Montgomery, AL 36111-2711	Standard ↓   Duplicate ↓
*Place of Service:		Select a Place of Service Acute Hospital Inpatient Rehabilitation Skilled Nursing Facility Observation Outpatient Facility         To verify a notification is required, refer to Notification Requirements
*Corporate Tax ID Owner:		Select a Corporate Tax ID Owner PHYSICIAN SALLY
*Facility Tax ID:		Select a Tax ID 721356674
*Facility Name:		Select a Provider SALLY PHYSICIAN, MD
*Physician/Provider Address:		Select an Address 130 Main Road, Montgomery, AL 36111-2711	Standard ↓   Duplicate ↓

Patient Information

Eligibility for:	BOB PATIENT  View Patient's ID Card  View Health Messages	Relationship:	Employee	Eligible for Language Assistance:	No
Subscriber #:	000000001	Effective Date:	07/01/2006	Verbal Language Preference:
Group #:	704335	Termination Date:		Written Language Preference:
Product:	Choice Plus     Definity CDHP	Insurance Type:	Commercial