Hospital Provider Form

If you're looking to submit a claim for a patient as a hospital provider please complete the form below, upload the required documents and HIF will process the claim.

Please submit only 1 claim per webform. 

Please enter the name of the hospital provider
Please enter the hospital provider number
Please enter a contact phone number
Please enter the contact email address
Please enter the name of the HIF member
Please enter the HIF member number
Please enter any supporting information for your claim
Please upload any relevant documents to support your claim