Provider Cover Forms

Our cover forms are to be used for:

• Claims Disputes
• Clinical Appeals
• Claims-Related Documents

Effective October 1, 2025, completion of the Claims Disputes Provider Form will be required to process your request. Here are the two ways you can send us a dispute:

• The Easiest Way: The best way to send in a dispute is through our Provider Portal. There is a simple version of the form there that is easy to fill out and send online. You can also track the progress of your dispute on the portal.
• By Fax or Mail: If you want to fax or mail your dispute, you must fill out and send in the required Claims Disputes form below.

For member forms, including authorization requests, please refer to hioscar.com/forms and select your specific market.