Fill out the Demographic information and attach a copy of the receipts of invoices associated with the claim to the reimbursement claim form. Proof of payment of the invoice can be in the form of a redacted credit card statement, an invoice showing no balance due or a cashed check image.
Check with your provider that the correct codes have been added to the form to ensure a prompt reimbursement. It is absolutely necessary to include all receipts or invoices in order for EHP to properly process the claim.