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.

Hospital name

Please enter the name of the hospital provider

Hospital provider number

Please enter the hospital provider number

Provider contact phone number

Please enter a contact phone number

Provider contact email address

Please enter the contact email address

HIF member name

Please enter the name of the HIF member

HIF Member number

Please enter the HIF member number

Additional information

Please enter any supporting information for your claim

Supporting documents

Please upload any relevant documents to support your claim

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Hospital Provider Form

Hospital Provider Form