To file a claim against the City for bodily injury, auto, and property damage, you must complete the General Claim Form. A. Insurer Letter – This letter should match the insurer provided in section 3a. b.Gov or faxed to 717-772-1550. Report a Claim - you can expedite the handling of your claim. ○ All fields must be completed. Com or fax to (555) 123-4567. The form below is to submit inquiries related to insurance authorizations. Or, call our Provider Priority Line at 800-TRY-CHOP (and Press 2). Important Information to Successfully Submit Your Application Form. Mississippi Medicaid, HealthCare.gov.