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Claim Correspondence This form may be used to submit general correspondence such as: Providers Outside of Minnesota   Minnesota Providers Requested information Claim attachments Appeals/Adjustments   Requested information Attachments must use the Claim Attachment Form Adustments and appeals must use the Claim Adjustment/Appeal Form Step 1 of 2: Claim Information * Required Fields * Product Type: HealthPartners Fully Insured and Self Insured Products HealthPartners Government Programs Senior/Medicare Products HealthPartners Dental   Provider/Contact Information: * Provider Name: * Billing Provider ID#:  ?Billing Provider ID includes: Payee NPI, Tax id "xx-xxxxxxx", or UMPI * Contact Person: * Phone Number: * Contact Email:     Member/Claim Information: * Member Name: * Member Number: * Date of Service: * Billed Charges:    Claim Number:   Comments/description: