Employee Access

Employee Service Request

* indicates required information  
* Employer Name:
* Employee Name:
* Employee Tel No.: ( ) -
  Alternate Tel No.: ( ) -
* Email Address:
  For Claims Assistance:
  Patient Name:
  Provider Name (Dr. / Hospital):
  Date of Service:
* Please provide as much detail as
possible about the nature of the request:

Additional information such as invoices, claim statements, physician bills, EOB's or other correspondence and insurance related documents can be emailed or faxed to our office at the numbers below.

Email: helpme@msibg.com
Fax: 770-425-4722
Toll Free Fax: 800-580-2675

You may also contact our office during normal business hours at:

Tel: 770-425-1231
Toll Free Tel: 800-580-1629