NOMINATE A PROVIDER Nominate a Provider Nominee's Name * Hospital, Facility, or Practice Office Phone Street Address City State Zip Reason for Nomination New OptionCouldn't find on lookup screenClaim denialPatientBilling company Submitter's Email Address (if you wish to be contacted about your submission) Only if you wish to be contacted about your submission. Submitter's Name Submitter Type Choose TypeI am a providerI am an employer or payorOther Email Submit Δ Top