Insurance Data Collection Form
This is ONLY for data collections as requested in the most recent video - DO NOT use this form to submit your questions to the PCA Insurance Committee.
Click or drag files to this area to upload. You can upload up to 5 files.
Note: Upload your file using the following format Last Name, First Name - Highmark Error - Date
Please be advised that the information you submit shall be received by the PCA office, the PCA Insurance Committee, and/or PCA General Counsel.  As such, please refrain from sending or sharing any protected patient health information as defined by the Health Insurance Portability and Accountability Act (HIPAA).  Sharing protected patient health information without proper authorization is a violation of federal law and may result in serious legal consequences.  There is no guarantee of completeness or accuracy in any response you receive.  Any response from the PCA, the PCA Insurance Committee and/or PCA General Counsel is without a warranty of any kind, express or implied and should not be taken or construed as legal advice.  While we take your privacy seriously, there are circumstances in which the information could be disclosed.  By submitting your information, you acknowledge and accept this risk.  If you have any concerns about confidentiality, please refrain from providing sensitive information.