Wiki Template for Fee Charging

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I am looking for a template to send the insurance charging for record collection. Anyone has created such a template that they can share?
 
Are you contracted with the insurance companies who are requesting records? If so, it is likely in your contract that you have to provide the records necessary in order to review a claim or PA to determine medical necessity.
 
Are you contracted with the insurance companies who are requesting records? If so, it is likely in your contract that you have to provide the records necessary in order to review a claim or PA to determine medical necessity.
That was where I was going with my question.
 
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