FSA TPA, LLC fax number

Fax destination details

Department

FSA TPA Tribal Benefits Team (Tribal Health Benefit Program)

Purpose

Submitting provider payments and claim reimbursements; sending/receiving communications related to tribal health benefit program (provider payments, reimbursement forms, benefits communications).

Form

Provider Payment Authorization Form — Provider Payment Authorization Form

Address

PO Box 1210, Atmore, AL 36504

Voice phone

(844) 969-8777

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the Provider Payment Authorization Form with participant details (Name, Tribe, Tribal Roll Number, etc.), attach supporting documentation (billing statement, contract), and submit to FSA TPA. Payments are issued as checks to providers and may be recurring; ensure documentation is included to adjudicate the payment.

Official form instructions are published as a downloadable file on the organization's website.