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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FIS2366
for the current year.
Form FIS2366 Surprise Medical Billing Arbitrator Application, Annual Attestation, and Change of Information - Michigan
What Is Form FIS2366?
This is a legal form that was released by the Michigan Department of Insurance and Financial Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is FIS2366?
A: FIS2366 is a form for Surprise Medical Billing Arbitrator Application, Annual Attestation, and Change of Information in Michigan.
Q: Who needs to fill out FIS2366?
A: This form needs to be filled out by Surprise Medical Billing Arbitrators in Michigan.
Q: What is the purpose of FIS2366?
A: The purpose of FIS2366 is to apply as a Surprise Medical Billing Arbitrator, provide annual attestation, and report any changes in information.
Q: Are there any fees associated with FIS2366?
A: There may be fees associated with FIS2366. Please refer to the instructions or contact the relevant department for more information.
Form Details:
- Released on May 1, 2021;
- The latest edition provided by the Michigan Department of Insurance and Financial Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FIS2366 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.
Download Form FIS2366 Surprise Medical Billing Arbitrator Application, Annual Attestation, and Change of Information - Michigan
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