Document Uploader

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Document Uploader

This page offers a convenient and secure way to upload documents to our office for review and processing.

Relationship to patient:

Member Number:

Patient full name:

Patient date of birth: (mm/dd/yyyy)

Submitter name

Submitter phone number:

Submitter email:

I am the patient or I have permission from the patient to upload documents on their behalf

Yes

Select the document types you would like to upload (select all that apply).

Select all document types that apply to your submission.
To add an additional file under each type, click "Add another [Document Type] document."
Total upload document(s) size limit per submission is 25 MB.
Acceptable file types are: .doc, .docx, .xlsx, .xls, .pdf, .jpg, .png, .txt, .jpeg
To avoid possible issues with the upload, the file name should only include letters and/or numbers. Avoid spaces, commas and any special characters such as ():;-?!{}[]|#$%&@*

Upload FAQ: https://tafcares.org/upload-qa/

Audit Documentation

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Enrollment Applicaiton

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Health Insurance Plan Details

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Power of Attorney Documentation

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Program Agreements/HIPAA Documentation

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Reenrollment Application

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Waitlist Application

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Reimbursement Request

Attachments

There is a limit of 5 attachments in a single upload.

Coverage Year

Coverage Month

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

Other

Attachments

There is a limit of 5 attachments in a single upload.

Case Number:

If provided on source communication or by Patient Advocate.

Comments:

If you are experiencing technical difficulty or need assistance uploading documentation, please contact a Patient Advocate.
Monday–Friday
855-845-3663
8 a.m. - 7 p.m. ET

Audit Documentation	Enrollment Application
Health Insurance Plan Details	Power of Attorney Documentation
Program Agreements/HIPAA Documentation	Reenrollment Application
Reimbursement Request	Waitlist Application
Other