Please select an option below. If you have any questions on claim submission, please be sure to contact us at (631) 719-8027 or send an email to firstname.lastname@example.org.
(Note: Save the sample spreadsheet, do not simply open it. Saving this to your desktop will allow for faster claim preparation in the future.)
Outlook Users – Please click here to download an email template to simplify individual claim placement.
Print your claim information and either fax or mail it to us. For your convenience, here is an electronic claim form in Excel format. (Note: Save the electronic claim form, do not simply open it. Saving this to your desktop will allow for faster claim preparation in the future.) Fax# 631-425-8862 Mailing Address: AG Adjustments PO Box 9090 Melville, NY 11747
Supporting documents for a claim may be submitted via any method (mail, fax or website). Please supply enough information so we know which claim your follow up documents correlate to. Click here to submit supporting documents online.