Hearing Services Program claim for payment form

Providers must have a digital or physical claim for payment form for every claim, and the form can also be used submitting manual claims.

Scroll down to access downloads and media.

This form is mandatory for every claim. Keep a copy of the completed claim form on the client’s record.

About this resource

Publication date:

January 2025

Publication type:

Form

Language:

English

Part of a collection:

Tags: