Generic Invoice - Medical and Health Care (Form 83D128)
Health care providers can use this form to invoice us for medical and health care.
You can also invoice us using our online portal, My Provider Services. To get started, you’ll need to set up an account with us. Once you’re set up, you can log in to save draft invoices, attach additional documents to your invoice, get confirmation when we receive an invoice, and see status and payment details. See our health care provider pages for more details.