Provider Feedback - Verda Healthcare

Hidden

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

Issue Type(Required)

Provider Name or ID(Required)

Description of Issue(Required)

How Can We Reach You?

Name(Required)

First Last

Email(Required)

Your Phone(Required)

Other ways to report incorrect or missing Provider data:

Email us at: ProviderServices@VerdaHealthcare.com
Call us at 1-888-256-5123 (TTY: 711), select 2 for Providers and then select 4 for Provider Services
Mail to: Verda Health Plan of Texas, ATTN: Provider Services, 7755 Center Ave. Suite 1200, Huntington Beach, CA 92647