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MAXIMUS FEDERAL SERVICES, INC.
Independent Bill Review
P.O. Box 138006
Sacramento, CA 958138006
Fax: (916) 6054280INDEPENDENT BILLING REVIEW FINAL DETERMINATION
July 30, 2015IBR Case Number:
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What is reversed and form claim?
Reversed and form claim is a process of requesting a refund or reversal of charges.
Who is required to file reversed and form claim?
Any individual or organization who believes they were wrongly charged or billed.
How to fill out reversed and form claim?
To fill out a reversed and form claim, provide all necessary information regarding the charge or billing error.
What is the purpose of reversed and form claim?
The purpose of reversed and form claim is to correct billing errors and obtain a refund if necessary.
What information must be reported on reversed and form claim?
The reversed and form claim must include details of the charge, reason for dispute, and supporting documentation.
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