Claim Submission

Submit a Claim for Reimbursement

For verified healthcare providers and pharmacies. Submit treatment claims for DHK LIFT patients and receive direct payment.

Step 1

Provider & Patient

Step 2

Treatment Details

Step 3

Claim Amount

Step 4

Documents

Step 5

Review

Step 1 of 520% Complete

Provider & Patient

Provider & Patient Info

Who is submitting the claim and for whom?

Provider Name *

Provider Type *

License Number *

Patient Name *

Application ID *

Assigned Fund *

Need Help?

Contact our claims team at claims@dhklift.org