General Customer Data Notification Questions

Responses to this form may take up to 2 to 4 business days.

Company Name *

Company Street Address *

Company City *

Company State *

Company Zip *

Company Relationship with Change Healthcare *

Payer

Provider

Partner

Company's Change Healthcare Account Number *

Can be found on contract or invoice.

Product(s) *

Please refer to the Solution Status page for product name

Contact Name *

Contact Email *

Communication Received *

Email

Letter

Both

Customer Question *

*

Send me a copy of my responses