Report a Problem

Have you found any inaccurate data on Find a Provider? Use this form to help us ensure that the Provider data on our Find a Provider tool is accurate.

If you would like to submit this information by phone, or if you have any questions please contact us at:

Phone: 1-833-919-3214

Required fields are marked with an asterisk (*)

Are you a Member, Prospect, Provider or Broker? * Member Prospect Provider Broker

Provider NPI * NPI can be found on the Ambetter Guide under provider details.

Provider Name *

Provider Specialty *

Provider Address * Ex. 123 Test Street, City, State 12345

Provider Phone Number *

If "other" was selected, please provide additional information.

This form will send your message to [NAME_HIM] as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with [NAME_HIM] through email, you accept associated risks. [NAME_HIM] does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your PHI, please send us a message through the Secure Member or Provider portal.

Agency Contact Information

National Producer Number (NPN) *

Agent/Broker Name *

Agent/Broker Phone Number *

Agent/Broker Email Address *