Prior Authorization Required. Fields marked with (*) are required

Complaint- every claim must have a complaint.

Example: ABS light is on

Cause: Do not Write (broke), doesn’t work etc.

Example: right rear sensor open

Correction: The correction must describe the repair in detail in order to capture labor operations. Example: Remove RR wheel and replace sensor, clear code, reassemble and road test.

Claim Information

3 C's