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Submit to: AmeriHealth Administrators Administrative Appeals P.O. Box 21974 Reagan, MN 55121 FAX to: (215) 761-0956 YOU MUST COMPLETE A SEPARATE APPLICATION FOR EACH CLAIM APPEALED. A. Provider Information

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Signature must be complete means that all required fields or sections that need to be signed have been filled out and signed by the appropriate individual.

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Anyone who is authorized to sign a document or form that requires a signature must ensure that the signature is complete.

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To fill out a complete signature, the individual must carefully read the document or form, sign in the designated signature line, and provide any additional information required.

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The purpose of requiring a complete signature is to ensure that all necessary parties have approved or agreed to the contents of the document or form.

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The signature must include the individual's full name, the date of signing, and any additional information required by the document or form.