When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself. *PLEASE SUBMIT ONE FORM PER DATE OF SERVICE* To submit an inquiry for your claim we'll need a little more information. Please verify with your records that you have not already received a payment in the past week. DO NOT USE THIS FORM if you have NOT submitted a claim already. TO SUBMIT A CLAIM: Electronically:Payer ID: 86145 By Mail: Redirect Health Administration, LLC P.O. Box 211533 Eagan, MN 55121 *PLEASE SUBMIT ONE FORM PER DATE OF SERVICE* Please click below to download the No Surprises Act (NSA) Open Negotiation Form. https://www.redirecthealth.com/wp-content/uploads/2025/05/RDH-IDR-negotiation-request-form.pdf Redirect Health Administration, LLC Independent Dispute Resolution (IDR) Contact Information: 2020 N Central Ave, Ste 400 Phoenix, AZ 85004 NSArequests@redirecthealth.com Inquiry Type(Required)(this form not intended for submitting a claim- see above) Claim or Payment Status EOB Detail Request Overpayment Payment Not Received Appeal Payment Patient Account/Control Number(Required)(this should match what was provided on the claim submitted)Insured ID Number(Required)Claim IDPatient First Name(Required)Patient Last Name(Required)Patient Date of Birth(Required) Date of Service(Required) Billed Amount on the Claim $(Required)Please enter a number from 0 to 9999999999.99.Contact First and Last Name(Required)Contact Email(Required)(To ensure a response, please include a valid email address.) Office Phone(Required)ExtensionFax NumberProvider Specialty(Required) PCP Urgent Care Pediatrics Chiropractor Lab LabCorp X-Ray Advanced Imaging Gyn-CPE Specialist (Psych) Specialist (OT/PT/ST) Hospital Specialist Specialist - Office Emergency Room Hospital - Outpatient Hospital - Inpatient Home Health DME How Can We Help You?(Required)
