Po box 30755 salt lake city ut 84130

Claim submissions should be in a HIPAA-compliant 837 I or P format. For paper submissions and correspondence, use: Mid-West Optum Care Claims. Indiana P.O. Box 30781. Ohio Salt Lake City, UT 84130. Mountain West Optum Care Claims. Arizona P.O. Box 30539. Colorado Salt Lake City, UT 84130.

Find out more. Free and open company data on Utah (US) company TRANSFORM KM LLC (company number 11167791-0161), 5407 TRILLIUM BOULEVARD SUITE B120, HOFFMAN ESTATES, IL, 60192.PO Box 30755 . Salt Lake City, UT 84130-0555. 1-800-788-5614 . 1-866-216-9926 TDD . www.liveandworkwell.com website access code: 702633 . The Vanguard Group (Savings)PO Box 30568 Salt Lake City, UT 84130-0568. Blue Shield of California Dental Claims Unit PO Box 272540 Chico, California 95927-2540. APIPA PO Box 30751Contact Us. UnitedHealthcare Global is dedicated to protecting the health, well-being and safety of globally mobile populations. Contact us to learn more about how we can help …P O Box 30755 Salt Lake City UT 84130-0755. When Medicare is the primary payer, and will not cover your services, call the Plan at 703-729-4677 or 1-888-636-NALC (6252) to obtain benefits. Claims for Medicare-primary patients should be submitted to: NALC Health Benefit Plan for Employees and Staff P O Box 678 Ashburn, Virginia 20146

PO Box 30547 Salt Lake City, UT 84130-0547. Self-funded ID cards. Self-funded ID cards are green and will show the logo of the employer as well as the Kaiser ...P.O. Box 278 Quincy, MA 02171. Prior Authorization Unit Contact us if you need help with General Prior Authorization Phone: (800) 862-8341. MassHealth Fraud Hotline Contact us if you need help with Reporting fraud Phone: (877) 437-2830 (877)-4-FRAUD-0) Last updated: June 29, 2023:P.O. Box 30531 Salt Lake City, UT 84130 . Key Phone Numbers: Provider Enrollment: 1-844-463-7768; Recipient Enrollment: 1-855-642-8572;PO Box 30568 Salt Lake City, UT 84130-0568. Blue Shield of California Dental Claims Unit PO Box 272540 Chico, California 95927-2540. APIPA PO Box 30751Hours: None Listed. Tags: ... Hampton Inn Salt Lake City Central ; Discover Bank, PO Box 30416, Salt Lake City, UT... Discover Bank, PO Box 30416, Salt Lake City, UT 84130-0416 In order for your request to be processed, we require the following documentation: 1. S Navajo St, Salt Lake City, UT 84104 - 65030363... Salt Lake City, UT ...P.O. Box 30555 Salt Lake City, UT 84130 Fax: 1-801-567-5499 Optum Rx Customer Service: Phone (toll-free): 1-800-357-1371 • Benefit questions • Claim questions • Verify …Reviews and ratings United Health Care (Po box 30990) in Salt lake city (Utah), phone 8007829883. Address Po box 30990.

P.O. Box 30783 Salt Lake City, UT 84130. Please note you cannot submit claims through the UnitedHealthcare Provider Portal for GEHA members. Questions? Check the member’s ID card for contact information. For eligibility, summary of benefits, precertification requirements and claim status, visit uhss.umr.com or call 1 of the following:Calling Member Services at 800-538-5038. Submit claims to us via: Electronic Data Interchange (EDI) transactions. U.S. Mail to: P.O. Box 30192 SLC, UT 84130 (for Commercial/Medicaid/CHIP) P.O. Box 30196 SLC, UT 84130 (for Medicare claims ONLY) Monitor submitted claim status by: Using the Provider Benefit Tool. Learn more .P.O. Box 30567 Salt Lake City, UT 84130-0567. Review the Client reference guide for additional submission addresses. Healthplex Review the Healthplex Client Reference ...Complete Po Box 30755 Salt Lake City Ut 84130 within a few moments by simply following the instructions below: Choose the document template you want from the collection of legal form samples. Click on the Get form key to open it and start editing. Submit all of the requested boxes (they are yellow-colored).PO BOX 30541 SALT LAKE CITY, UT-84130-0541: 39026: UMR Provider Phone Number 1-800-826-9781: United Medical Resources UMR (Behavioral Health Claims) PO Box 1854, Hicksville, NY 11802-1854: 39026: 1-877-842-3210: United Healthcare Oxford(Medical Claims) PO BOX 29130 HOT SPRINGS, AR 71903:PO Box 30766 Salt Lake City, UT 84130-0766 For reconsiderations that did not deny for medical necessity see, Post service: Claims payment review & reconsideration process .

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PO Box 30755, Salt Lake City, Utah 84130 (800) 720-4158: Asuris Northwest Health: PO Box 30271, Salt Lake City, Utah 84130 (888) 344-5587: Select Health Plan:P.O. Box 30512 Salt Lake City, UT 84130-0512 . Telephone: (800) 999-9585. Fax: (855) 312-1470 . Members may request your assistance with any aspect of the complaint process. The . Member Grievance Form. and complaint filing instructions located in . Appendix D. must be readily available at your office location and promptly provided to the ...Paper Claims: P.O. Box 30783, Salt Lake City, UT 84130-0783 . PPO Plus plans: Providers in Massachusetts and New Hampshire: Mass General Brigham Health Plan Provider Service: 855-444-4647 Payer ID: 04293 Paper Claims: PO Box #323, Glen Burnie, MD 21060 Providers outside of Massachusetts and New Hampshire: UnitedHealthcare Shared ServicesPO Box 30758 . Salt Lake City, UT 84130 . Overnight Paper Claims . Address . LASON – SCS RMO . PO Box 30758 - URN . 4050 South 500 West, Suite 50 . Salt Lake City, UT 84123 . www.myoptumhealthcomplexmedical.com. OptumHealth Care Solutions offers a Health Care Provider an extranet site to helpPO Box 30978 Salt Lake City, UT 84130-0555 Customer Service and Claims 1-800-638-3120 Fax: 1-248-733-6060 www.myuhcvision.com Optum (EAP) all HEWT Participants PO Box 30755 Salt Lake City, UT 84130-0555 1-800-788-5614 1-866-216-9926 TDD www.liveandworkwell.com website access code: 702633 or HEWT Express Scripts, Inc. …Jan 7, 2023 · We strongly believe the postal address PO Box 30555, Salt Lake City, UT 84130-0555 is owned by UnitedHealthcare. The mail came from Salt Lake City, UT. For further details, you can call the provider phone number (800) 842-1126, or send UnitedHealthcare an email to the address [email protected]. Please we encourage you to visit the ...

P.O. Box 30766 Salt Lake City, UT 84130; Second Level Reconsideration: Reconsideration Time Frame: Providers have 40 days from the notification date of denial . Office of Insurance Commissioner at: 1-800-562-6900; Note: All inquiries regarding Second Level Reconsiderations for the Balance Billing Protection Act will need to go directly to the OICPO Box 30547 Salt Lake City, UT 84130-0547 . NCAL KPIC Self-Funded Program Provider Manual 2021 35 Section 5: Billing and Payment ... PO Box 853915 Richardson, TX 75085-3915 Customer Claims Service Department Monday through Friday 8:00 am to 5:00 pm Pacific Time 1-888-505-0468PO Box 30781 Salt Lake City, UT 84130-0781 After you’ve filed a reconsideration through paper mail, questions and updates on the request are available by calling 866-565-3468. Medicare Denials: If a claim was denied by Medicare and you feel it to be in error, you have the right to appeal the decision to Medicare.P.O. Box 30567 Salt Lake City, UT 84130-0567. Review the Client reference guide for additional submission addresses. Healthplex ... PO Box 30568 Salt Lake City, UT 84130-0568. Blue Shield of California Dental Claims Unit PO Box 272540 Chico, California 95927-2540. APIPA PO Box 30751PO Box 30547 Salt Lake City, UT 84130-0547. Self-funded ID cards. Self-funded ID cards are green and will show the logo of the employer as well as the Kaiser Permanente logo. The example below illustrates the general appearance of Self-funded ID card.Salt Lake City International Airport is a bustling hub for travelers from all over the world. If you’re planning a trip to Salt Lake City and want to explore the surrounding area a...P.O. Box 30555 Salt Lake City, UT 84130 Fax: 1-801-567-5499 Optum Rx Customer Service: Phone (toll-free): 1-800-357-1371 • Benefit questions • Claim questions • Verify eligibility • Notification of upcoming service • Request ID cards • Physician verification • Prescription administration • Behavioral health • Employee ...Sinclair Services Health. Sinclair Services Health main address is PO Box 30827 , Salt Lake City, Utah 84130-0827, main phone number 888-800-2230. This is the best Sinclair Services Health phone number where you can speak to a real person and get assistance with your medical insurance issue.P.O. Box 5290 Kingston, NY 12402-5290. Community Plan Behavioral health P.O. Box 30760 Salt Lake City, UT 84130-0760. ACC/DD/Dual Complete 800-445-1638. Dual Complete® (HMO D-SNP) Attn: Provider claim disputes P.O. Box 31364 Salt Lake City, UT 84131-0364. General claim disputes P.O. Box 31364 Salt Lake City, UT 84131-0364. HMO-SNP Part D only ...

PO Box 30547 Salt Lake City, UT 84130-0547. Self-funded ID cards. Self-funded ID cards are green and will show the logo of the employer as well as the Kaiser ...

P.O. Box 30751 Salt Lake City, UT 84130. Local Utah Trust Office Eighth District Electrical Fringe Benefit Funds 5295 South Commerce Dr, Suite 220 Murray, UT 84107. Local Denver Trust Office Eighth District Electrical Fringe Benefit Funds 4704 Harlan Street, Suite 104 Denver, CO 80212. Remit Address: Regular Mail Eighth District Electrical ...Zip Code 84130 Map. Zip code 84130 is located mostly in Salt Lake County, UT.This postal code encompasses addresses in the city of Salt Lake City, UT.Find directions to 84130, browse local businesses, landmarks, get current traffic estimates, road conditions, and more.. Nearby zip codes include 84123, 84107, 84184, 84129, 84115.Lake Oswego, a beautiful city in Oregon, is known for its stunning landscapes and vibrant community. The weather in this region can be quite unpredictable, with sudden changes and ...If your account number starts with 456: Regions | EnerBank USA PO Box 30122 Salt Lake City, UT 84130-0122; ... EnerBank USA PO Box 26856 Salt Lake City, UT 84126-0856; Send a payment via overnight delivery. Regions | EnerBank USA 650 S Main St, Suite 1000 Salt Lake City, UT 84101. Payments over the phone. Call Customer Service at …Salt Lake City. United Behavioral Health. PO Box 30755, Salt Lake City, Utah 84130. (800) 720-4158. Find and Insurance Provider Near Me.Looking for the top activities and stuff to do in Zion National Park, UT? Click this now to discover the BEST things to do in Zion - AND GET FR Feel like you’ve been transported to...Regence Blue Shield of Utah main address is PO Box 30271 , Salt Lake City, Utah 84130-0271, main phone number 800-762-6004. Skip to content. Medical Insurance. ... Regence Blue Shield of Utah Address: PO Box 30271 City: Salt Lake City State: Utah ZIP …P.O. Box 30573 Salt Lake City, UT 84130-0573 Fax: 801-567-5498 Dental Issues Appeals/Grievance Coordinator . Grievance & Appeals Department P.O. Box 30569 Salt Lake City, UT 84130-5690 Fax: 714-364-6266 Mental Health Issues Behavioral Health . National Appeals Team Attn: Appeals Department P.O. Box 30512 Fax: 855-312-1470 Vision IssuesPhone: 800-331-6353. Fax: 801-595-4440. E-Prescribe: 4602745. www.depotdrug.com. OptumRx (PBM) Prior Authorization: 800-626-0072. Pharmacy Help Desk: 800-880-1188. Iron Road, formerly UPREHS, is proud to be the trusteed health ally for Union Pacific employees since 1947.P.O. Box 30569 Salt Lake City, UT 84130 . Salt Lake City, UT 84130-5690 Fax: 714-364-6266 . Fax: 714-364-6266 . 5 Rev. Aug. 2020 . Neither you nor your treating provider is responsible for the cost of any external independent review. The process: There are two types of Level 3 appeals, depending on the issues in your case:

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P.O. Box 30783 Salt Lake City, UT 84130-0783 UHC Provider Services Phone: (877) 343-1887 If the patient has Medicare primary coverage, mail to GEHA: GEHA FEHB Medical P.O. Box 21542 Eagan, MN 55121. UnitedHealthcare Choice Plus (all 50 states) EDI Payer ID #39026 UnitedHealthcare Shared Services P.O. Box 30783, Salt Lake City, UT 84130-0783P.O. Box 30559 Salt Lake City, UT 84130; Standard appeals fax: ... P.O. Box 740800 Atlanta, GA 30374-0800. Durable Medical Equipment/Respiratory and Commodity Services.300 Customer Case Studies Document Health Catalyst's Efforts to Power Clinical, Operational, and Financial Improvements SALT LAKE CITY, June 23, 2... 300 Customer Case Studies Docu...PO Box 99006 Lubbock, TX 79490-9006 United States. ... HealthSCOPE Benefits PO Box 30962 Salt Lake City, UT 84130. Downloads. HealthSCOPE - Whirlpool-Payor conference deck.pdf. Resources. Find a facility; Find a physician; Find a practice; Find participating insurance; News; Services. Call Care; Disability Management;UH EAP CLAIM FORM. CLAIMS DEPARTMENT PO Box 30755 Salt Lake City, UT 84130-0755. 1-800-333-8724. Use ONLY for Certified EAP Visits.PO Box 30757 : Salt Lake City, UT 84130-0757 248-733-6085 . PO Box 30757 . Salt Lake City, UT 84130-0757 . Medica Health Plan . 801-994-1076 : PO Box 30990 .P.O. Box 30539. Salt Lake City, UT 84130. You can choose to initiate the debit process. This process will apply future claims payment against the amount owed until the debt is satisfied. Please sign the letter and return it to the address listed above. Please be advised that if a refund is not received within 30 days futureP.O. Box 30573 Salt Lake City, UT 84130-0573 Fax: 801-567-5498 Dental Issues Appeals/Grievance Coordinator . Grievance & Appeals Department P.O. Box 30569 Salt Lake City, UT 84130-5690 Fax: 714-364-6266 Mental Health Issues Behavioral Health . National Appeals Team Attn: Appeals Department P.O. Box 30512 Fax: 855-312-1470 … ….

Preferred Care Partners, Inc. P.O. Box 30769 Salt Lake City, UT 84130-0769. Enrollment Form Fax. Fill out the Enrollment Request Form and fax it to: 1-888-950-1169. Enrollment Form Welcome, New Members Questions? Call Preferred Care Partners 1 - 866-231-7201, TTY 711 .•HealthSCOPE Benefits, PO Box 30962, Salt Lake City, UT 84130 •United Healthcare Choice Plus Network for Lakeland •Preferred labs include Quest and LabCorp. •CAA compliance and transparency out-of-pocket amounts. •Copays highlighted for providers on the front of card. •Dependent names will be listed on card if coveredClaims. P.O. Box 30567. Salt Lake City, UT 84130-0567. UnitedHealthcare Dental. PTE/Prior Authorizations. P.O. Box 30552. Salt Lake City, UT 84130-0552. Review the …Calling Member Services at 800-538-5038. Submit claims to us via: Electronic Data Interchange (EDI) transactions. U.S. Mail to: P.O. Box 30192 SLC, UT 84130 (for Commercial/Medicaid/CHIP) P.O. Box 30196 SLC, UT 84130 (for Medicare claims ONLY) Monitor submitted claim status by: Using the Provider Benefit Tool. Learn more .PO Box 30541 Salt Lake City, UT 84130-0541 1-800-826-9781. INSTRUCTIONS FOR COMPLETING THIS FORM Page 2 Last page Please check with your provider before completing this form. UMR accepts dental claims electronically through the following clearinghouse: Envoy/Web MD Phone: 1-888-416-0673P.O. Box 30567 Salt Lake City, UT 84130-0567. Review the Client reference guide for additional submission addresses. Healthplex Review the Healthplex Client Reference Guide for claims submission addressIf your account number starts with 456: Regions | EnerBank USA PO Box 30122 Salt Lake City, UT 84130-0122; ... EnerBank USA PO Box 26856 Salt Lake City, UT 84126-0856; Send a payment via overnight delivery. Regions | EnerBank USA 650 S Main St, Suite 1000 Salt Lake City, UT 84101. Payments over the phone. Call Customer Service at …There’s nothing like spending a day on the water to refresh and recharge. If you love to fish, you probably have a fully stocked tackle box with all the accessories you need for a ...Salt Lake Tribune obituaries are an invaluable resource for those seeking information about the lives and legacies of loved ones in the Salt Lake City area. These obituaries provid... Po box 30755 salt lake city ut 84130, - Deal values world's leading private owner and operator of football clubs at US$4.8 billion post-investment- Silver Lake making a primary capital... - Deal values world's leading ..., P.O. Box 30567 Salt Lake City, UT 84130-0567. Review the Client reference guide for additional submission addresses. Healthplex Review the Healthplex Client Reference ..., Find the correct mailing address for your Optum claim based on your customer type and plan. For Salt Lake City UT, the PO box for employer groups is 30755, while the PO box …, UT. 84130-0602. Ventura County Health Care Plan. 30755. Salt Lake City. UT. 84130-0755. Optum EAP. Please submit EAP claims to the Behavioral Health claims submission address on the consumer ID card., Regence Bcbs Of Or. PO Box 30805, Salt Lake City, Utah 84130. (800) 722-5086. Find and Insurance Provider Near Me., PO Box 30757 . Salt Lake City, UT 84130-0757 ; Mail Handlers . UHCBP of CA ; PO Box 30756 . Salt Lake City, UT 84130-0756 : 1-877-262-2193 . P.O. Box 30755 . Salt Lake …, Contact Us. UnitedHealthcare Global is dedicated to protecting the health, well-being and safety of globally mobile populations. Contact us to learn more about how we can help …, Complete Po Box 30755 Salt Lake City Ut 84130 within a few moments by simply following the instructions below: Choose the document template you want from the collection of legal form samples. Click on the Get form key to open it and start editing. Submit all of the requested boxes (they are yellow-colored)., P.O. Box 30783 Salt Lake City, UT 84130. Please note you cannot submit claims through the UnitedHealthcare Provider Portal for GEHA members. Questions? Check the member’s ID card for contact information. For eligibility, summary of benefits, precertification requirements and claim status, visit uhss.umr.com or call 1 of the following:, 1-877-842-3210. United Medical Resources UMR (Medical Claims) PO BOX 30541 SALT LAKE CITY, UT-84130-0541. 39026. UMR Provider Phone Number 1-800-826-9781. United Medical Resources UMR (Behavioral Health Claims) PO Box 1854, Hicksville, NY 11802-1854., P.O. Box 278 Quincy, MA 02171. Prior Authorization Unit Contact us if you need help with General Prior Authorization Phone: (800) 862-8341. MassHealth Fraud Hotline Contact us if you need help with Reporting fraud Phone: (877) 437-2830 (877)-4-FRAUD-0) Last updated: June 29, 2023:, PO Box 30978 Salt Lake City, UT 84130-0555 Customer Service and Claims 1-800-638-3120 Fax: 1-248-733-6060 www.myuhcvision.com Optum (EAP) all HEWT Participants PO Box 30755 Salt Lake City, UT 84130-0555 1-800-788-5614 1-866-216-9926 TDD www.liveandworkwell.com website access code: 702633, PO Box 30180. Salt Lake City UT 84130-0180. Phone (801) 284-1150. Fax (801) 284-1184. Outreach Services. Person Stephanie Nichols Outreach Provider Relations. Phone ..., P.O. Box 30781 Salt Lake City, UT 84130-0781 Submit claim reconsiderations: By mail: Optum Care Network Claims P.O. Box 30781 Salt Lake City, UT 84130-0781 Check the status of your claim submission: Online: Optum Pro portal By phone: 866-565-3468 Please don’t submit duplicate claims unless you haven’t received payment or an, Orem, Utah, dubs itself “Family City U.S.A.” Corny, perhaps — but valid. Located 45 miles south of Salt Lake City, the town features quality schools… By clicking "TRY IT", I..., P.O. Box 30766 Salt Lake City, UT 84130; Second Level Reconsideration: Reconsideration Time Frame: Providers have 40 days from the notification date of denial . Office of Insurance Commissioner at: 1-800-562-6900; Note: All inquiries regarding Second Level Reconsiderations for the Balance Billing Protection Act will need to go directly to the OIC, You now have several options for submitting your requests for reconsideration to Optum: If you have a secure system, please submit reconsideration requests to: [email protected]. Or mail the completed form to: Provider Dispute Resolution PO Box 30788 Salt Lake City, UT 84130 NOTE: This form is for claim disputes and reconsiderations only., Non-SWHR contracted health care providers should submit 2022 claims to UnitedHealthcare by one of the following ways: Electronic: Payer ID 87726. Mail: UnitedHealthcare, P.O. Box 30975, Salt Lake City, UT 84130-0975. Groups HCFAC3-OUL, HCFAO4-OE7: UnitedHealthcare, P.O. Box 30765, Salt Lake City, UT 84130-0765., PO BOX 30783 ; Salt Lake City, UT 84130 -0783 Pharmacy claims (excluding drugs paid under a medical benefit) OptumRx P.O. Box 650334 Dallas, TX 75265 -0334 . Billing and Reimbursement-Account Resources . HARVARD PILGRIM HEALTH CARE-PROVIDER MANUAL F.10 March 2024 . Claims Requirements ., Fax: 877-291-3248. (Each fax will be reviewed in the order it is received by the Appeals Department) UMR – Claim Appeals PO Box 30546 Salt Lake City, UT 84130 – 0546., PO Box 30539 Salt Lake City, UT 84130 NOTE: This form is for claim disputes and reconsiderations only. To submit a formal appeal, please see the instructions listed on the back of your explanation of payment (EOP). *Provider Name: *Provider TIN: Provider Address: Provider Type: MD Hospital Home Health Mental Health Professional, PO Box 30769 Salt Lake City, UT 84130-0769. Close keyboard_arrow_up. Medicare Prescription Drug Plans Website technical support. ..., Address: PO Box 30277, Salt Lake City, UT 84130. Website: https://www.capitalone.com. People Also Viewed. American Title Loans; ... Mortgage Solutions powered by Vintage Lending (1) Sandy, UT 84092. Progressive Insurance. Salt Lake City, UT 84101. One Trust Home Loans-Spencer Adamson Mortgages; View similar Banks. Suggest an Edit. …, PO Box 30978 Salt Lake City, UT 84130-0555 Customer Service and Claims 1-800-638-3120 Fax: 1-248-733-6060 www.spectera.com Site Form A-6003-717 United Behavioral Health/Mental Health and Substance Abuse PO Box 30755 Salt Lake City, UT 84130-0555 1-800-788-5614 1-866-216-9926 TDD www.liveandworkwell.com, P.O. Box 30766 Salt Lake City, UT 84130; Second Level Reconsideration: Reconsideration Time Frame: Providers have 40 days from the notification date of denial . Office of Insurance Commissioner at: 1-800-562-6900; Note: All inquiries regarding Second Level Reconsiderations for the Balance Billing Protection Act will need to go directly to the OIC, Request a MassHealth Provider Manual (Include your provider number and a street address.) Email : [email protected]. Phone: (800) 841-2900. Hours: Monday–Friday, 8 a.m.–5 p.m. Mailing Address: MassHealth Customer Service. Attn: Provider Enrollment and Credentialing., Salt Lake City, UT 84130-0760 . PO Box 30755 ; Salt Lake City, UT 84130-0755 . Mail Handlers UnitedHealthcare . PO Box 30756 . Salt Lake City, UT 84130-0756 . PO Box ..., Address for Claims and Claim Appeals. Medica. PO Box 30990. Salt Lake City, UT 84130-0990. Attachment/Appeal Fax#. 1-801-994-1076. Claim Adjustment or Appeal Request …, Sinclair Services Health. Sinclair Services Health main address is PO Box 30827 , Salt Lake City, Utah 84130-0827, main phone number 888-800-2230. This is the best Sinclair Services Health phone number where you can speak to a real person and get assistance with your medical insurance issue., PO Box 30978 Salt Lake City, UT 84130-0555 Customer Service and Claims 1-800-638-3120 Fax: 1-248-733-6060 www.spectera.com Site Form A-6003-717 United Behavioral Health/Mental Health and Substance Abuse PO Box 30755 Salt Lake City, UT 84130-0555 1-800-788-5614 1-866-216-9926 TDD www.liveandworkwell.com, Salt comes from deposits on the Earth’s surface, underground sources and seas, lakes and oceans. Salt derives from various places, but it is most frequently extracted from watery s..., Oct 27, 2017 ... Kansas City Southern Railway Suppliers P.O. Box 219335 Kansas City ... Sinclair Oil Suppliers 550 East South Temple Salt Lake City UT 84130 USA, Or mail the completed form to: Provider Dispute Resolution PO Box 30539 Salt Lake City, UT 84130. NOTE: This form is for claim disputes and reconsiderations only. To submit a formal appeal, please see the instructions listed on the back of your explanation of payment (EOP). *Provider Name: *Provider TIN: Provider Address: Provider Type: MD.