For reconsideration of denied or reduced payment, please respond by submitting the following form. 

Should you have further questions, please contact CompIQ Corporation Provider Services at (949) 770-7828 ext 15, or fax (949) 770-7428.

Inquiry Form

Type of request:     
*Claim Number:  Document Ctrl No.: 
Patient Last Name:  Patient First Name: 
*Date of Service:  (e.g. 06/01/01) *Tax ID Number: 
Provider Contact Name: E-mail:
Phone Number: Fax Number:
Inquiry or Comments: