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Health services provider

Request to cancel a claim and/or preauthorization

Please submit the following claim information to us. Once the claim or preauthorization has been cancelled, you’ll receive a confirmation email and you can then resubmit the claim if need be. If you have any additional questions, please contact us directly at 1-800-588-1195.

Please enter the member name.

Please enter the date of service

Please enter the dollar amount claimed

Please enter the document or preauthorization number.

Please enter a valid email address.