Medical Mutual - Health Plans for Life

How do I inquire about or appeal a claim?

The PAR Form is used for all provider inquiries and appeals related to reimbursement. Providers may request corrective adjustments to any previous payment using this form. Medical Mutual will review the requests and make adjustments within 12 months from the date the initial claim was processed.

How to submit the PAR Form:

  • Log in to the Provider Portal and select the claim you need to inquire about in the Claims & Eligibility feature. Then, click the “Submit Inquiry” button to complete the necessary information and attach the appropriate files.
  • Fill in the required information below and attach any related medical records.

Note: Please use one form per patient or inquiry. Any fields with incomplete information may delay or cause your request to be returned unprocessed.

Questions or Postal Mailings? Please reference the PAR Form Instructions to determine the supporting documentation required for each type of request or what to do when a claim is returned unprocessed.


The unsecured Provider Action Request (PAR) form is temporarily unavailable.

To submit inquiries, please log in and navigate to the Claims and Eligibility feature, select claim, and click the “Submit Inquiry” button. Complete all necessary information and attach the appropriate files.

If you do not have an account, please register by following the instructions here.

Alternatively, if you are unable to log in you may access a PDF Version of the form with submission instructions.


Contact Information


If you have any questions regarding contracting, provider inquiry or other administrative policies and procedures Contact Us at the appropriate location.

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