Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Imperial Health Plan of California, Inc. before sending sensitive documents. FaxFlow is not affiliated with this organization.
Imperial Health Plan of California, Inc. fax number
(626) 380-9066
Enrollment Department
Used for: Submitting the Provider Attestation of Patient Diagnosis for SSBCI Eligibility form (and other enrollment-related paperwork) to Imperial Health Plan's Enrollment Department.
Fax destination details
- Department
- Enrollment Department
- Purpose
- Submitting the Provider Attestation of Patient Diagnosis for SSBCI Eligibility form (and other enrollment-related paperwork) to Imperial Health Plan's Enrollment Department.
- Form
- SSBCI Eligibility Attestation — Provider Attestation of Patient Diagnosis for SSBCI Eligibility
- Address
- PO BOX 60874, Pasadena, CA 91116
- Voice phone
- 1-800-838-5914
- 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 beneficiary information, diagnosis codes, and provider attestation; have the provider sign and date; fax the completed form to 626-380-9066 and mail to the Enrollment Department.
Official form instructions are published as a downloadable file on the organization's website.
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