Self-Insurance Medical Provider Billing Dispute form

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Title Self-Insurance Medical Provider Billing Dispute form

A form for Providers to submit disputes to the department regarding payment of medical provider bills

Document number F207-207-000
How to get this document
Keywords bil, bill payment, bills, complain, complaint, dispute, interest, medical billing, medical bills, medical provider bills, non-payment, provider, underpayment
Alt Language(s)
Valid dates 12/2012
Contact information Self-Insurance

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