Form 13560 - Health Plan Administrator (HPA) Return of Funds

Form 13560 is completed by Health Plan Administrators (HPAs) and accompanies a return of funds in order to ensure proper handling. This form serves as supporting documentation for any funds returned by an HPA and clarifies where the payment should be applied and why it is being sent.

The latest form for Form 13560 - Health Plan Administrator (HPA) Return of Funds expires 2021-01-31 and can be found here.