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Please use dark ink and print clearly To appeal a claim denial, a written request and a completed waiver of liability statement form must be submitted to viva medicare within 60 calendar days of the date on the claim denial letter. Enclose your original receipts and itemized statements

Keep copies for your records It may take up to thirty (30) calendar days after we receive your form and documents for you to be reimbursed (paid back). Receipts will not be returned

Mail the completed form to viva health no later than one (1) year after the date of service.

Manage your account, access claims, view your id card and more Access is free, easy, and secure Monthly premium plan change low income subsidy getting help from viva medicare filing a complaint (grievance) or appeal to viva medicare ending your membership If you have questions or complaints about your viva medicare plan or care that you have received, we want you to let us know right away

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Ask for the exact time limit for filing a medicare claim for the service or supply you got

If it's close to the end of that time limit and your doctor, provider, or supplier still hasn't filed a claim, you should file the claim. Do not staple or tape do keep copies for your records Receipts and statements will not be returned Mail the completed form to viva medicare no later than one (1) year after the date of service

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