Managed Care Issues
Your Name
First Name
Last Name
ALF Community Name
Member of FALA
Yes
No
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Managed Care Company
Do you have current issues with
Billing
Timely Payments
Recoupments
Case Management
All of the Above
Have you submitted a complaint to the plan?
Yes
No
Have you submitted a complaint to AHCA about your issues?
Yes
No
If Yes, was the issue resolved?
Yes
No
Details of outstanding Issue
Upload Your Supporting Documents
Browse Files
If you have reported complaints please make sure the tracking number is included.
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