2025 Reimbursement Form

Use one of the links below to submit the 2025 Half Hollow Hills Medicare Part B Reimbursement Form

2025 Claim Form

1. Print the form

2. Complete all required sections

3. Attach supporting documentation

4. Submit to HHH and await confirmation of receipt (directions on back of form)

File Electronically for 2025 (preferred method of receipt)

1. Click the link and enter the required information in the form

2. Attach supporting documentation electronically

3. Click SUBMIT — the emailed copy serves as your confirmation of receipt