Forms, Programs, and Certifications

A copy of the American Diabetes Association (ADA) recognition certificate should be sent to the following:

Illinois Medicare Audit and Reimbursement Attn: Pearl Mundy P.O. Box 7191 Indianapolis, IN 46207-7191 Phone: (317) 595-4322 Fax: (317) 841-4425	Indiana Medicare Audit and Reimbursement Attn: Pearl Mundy P.O. Box 7191 Indianapolis, IN 46207-7191 Phone: (317) 595-4322 Fax: (317) 841-4425
Kentucky Medicare Audit and Reimbursement Attn: Lana Rush P.O. Box 7141 Indianapolis, IN 46207-7141 Phone: (513) 852-4242 Fax: (513) 419-3622	Ohio Medicare Audit and Reimbursement Attn: Lana Rush P.O. Box 7141 Indianapolis, IN 46207-7141 Phone: (513) 852-4242 Fax: (513) 419-3622

If a certificate is not submitted, payment cannot be made for rendering this service

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