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FSA TPA, LLC fax number
(855) 673-6710
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FSA TPA Tribal Benefits Team (Tribal Health Benefit Program)
Used for: Submitting provider payments and claim reimbursements; sending/receiving communications related to tribal health benefit program (provider payments, reimbursement forms, benefits communications).
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.
Sources and verification
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