{"id":5911,"date":"2019-08-27T00:25:56","date_gmt":"2019-08-27T00:25:56","guid":{"rendered":"http:\/\/mportal.jipanetwork.com\/?page_id=5911"},"modified":"2019-08-29T19:35:35","modified_gmt":"2019-08-29T19:35:35","slug":"manage-claims","status":"publish","type":"page","link":"https:\/\/mportal.jipanetwork.com\/?page_id=5911","title":{"rendered":"Manage Claims"},"content":{"rendered":"\n<style>\nstrong {font-size:18px}\n<\/style>\n<table class=\"wp-block-table\"><tbody><tr style=\"vertical-align:top;\"><td colspan=\"3\" style=\"text-align:left;\"><img class=\"wp-image-5\" style=\"width: 200px;\" src=\"https:\/\/mportal.jipanetwork.com\/wp-content\/uploads\/2019\/08\/JIPA-Full-Logo_RGB_web2.png\" alt=\"\"><br><strong>PROVIDER SUPPORT<br>1.855.275.1270, OPTION 4<\/strong><\/td><td style=\"text-align:right;\" colspan=\"2\"><strong>MEDICAL CLAIM FORM<\/strong><br>Forward Form and Bills to:<br>JIPA Network\/Claims<br>PO BOX 2788<br>Kennesaw, GA 30156-9114 USA<br>fax: 1.770.810.3789<br>email: claims@jipanetwork.com<\/td><\/tr><\/tbody>\n<tr style=\"text-align:left\">\n<td colspan=\"3\"><label>Group\/Plan Name or Number:<\/label>\n<input name=\"plan\" id=\"plan\" type=\"text\" size=\"10\" maxlength=\"15\">\n<\/td>\n<td colspan=\"2\"><label>Insured&#8217;s ID Number:<\/label>\n<input name=\"idnumber\" id=\"idnumber\" size=\"15\" maxlength=\"15\">\n<\/td>\n<tr style=\"background-color:lightgrey\"><td colspan=\"5\"><label><strong>PART 1: MUST BE COMPLETED BY INSURER<strong><\/label><\/td>\n<\/tr>\n<tr>\n<td><label>Insured&#8217;s Last Name:<\/label><\/td>\n<td><label>First:<\/label><\/td>\n<td><label>Middle:<\/label><\/td>\n<td><label>Patient&#8217;s Birth Date:<\/label><\/td>\n<td><label>Patient&#8217;s ID Number:<\/label><td>\n<\/tr>\n<tr>\n<td><input id=\"inslname\" name=\"inslname\" maxlength=\"25\" size=\"25\" required><\/td>\n<td><input id=\"insfname\" name=\"insfname\" maxlength=\"15\" size=\"15\" required><\/td>\n<td><input id=\"insmiddle\" name=\"insmiddle\" maxlength=\"1\" size=\"1\"><\/td>\n<td><input id=\"patDOB\" name=\"patDOB\" maxlength=\"10\" size=\"10\" required><\/td>\n<td><input id=\"patIDNO\" name=\"patIDNO\" maxlength=\"15\" size=\"11\" required><\/td>\n\n<\/tr>\n<\/table>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>PROVIDER SUPPORT1.855.275.1270, OPTION 4 MEDICAL CLAIM FORMForward Form and Bills to:JIPA Network\/ClaimsPO BOX 2788Kennesaw, GA 30156-9114 USAfax: 1.770.810.3789email: claims@jipanetwork.com Group\/Plan Name or Number: Insured&#8217;s ID Number: PART 1: MUST BE COMPLETED BY INSURER Insured&#8217;s Last Name: First: Middle: Patient&#8217;s Birth Date: Patient&#8217;s ID Number:<\/p>\n","protected":false},"author":128,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/pages\/5911"}],"collection":[{"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/users\/128"}],"replies":[{"embeddable":true,"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5911"}],"version-history":[{"count":7,"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/pages\/5911\/revisions"}],"predecessor-version":[{"id":5918,"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=\/wp\/v2\/pages\/5911\/revisions\/5918"}],"wp:attachment":[{"href":"https:\/\/mportal.jipanetwork.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5911"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}