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Complete the claims submission form and let Shoreline take it from here!

Shoreline Claim Submission

Please complete this form to initiate the claims process

Practice Name

Name

First Name

Last Name

Additional Info

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I have read and agree to the terms of the Shoreline Medical Administration Business Associate Agreement. I understand that by submitting documents through this portal, I am entering into a legally binding electronic agreement with Shoreline Medical Administration, LLC.

Summary of Business Associate Agreement (BAA)

By agreeing above, you confirm that:

Use of Patient Information – You will only use or disclose Protected Health Information (“PHI”) as needed to submit claims or as required by law.
Safeguards – You agree to keep PHI secure and follow HIPAA privacy and security standards (administrative, physical, and technical safeguards).
Reporting – You must promptly notify Shoreline of any unauthorized use, disclosure, or security incident involving PHI.
Patient Rights – You will cooperate with Shoreline if patients request access to, or amendments of, their PHI.
Termination – If this agreement ends, PHI must be returned or destroyed, unless doing so is not feasible, in which case protections remain in place.
Liability – You agree to take responsibility for any unauthorized disclosures or HIPAA violations caused by your use of PHI.

The full legal terms of the Shoreline Medical Administration Business Associate Agreement are available here.