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FL-375. ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar .... FL- 372 /. CASE NUMBER: EE Divorce Judgment. REQUEST FOR JOINER OF ...
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What is fl-375 - mpiphporg?
FL-375 is a form used to report income received from the Medical Provider Network (MPN) to the California Division of Workers' Compensation (DWC).
Who is required to file fl-375 - mpiphporg?
Health care providers who are part of the MPN and have received income from providing medical services to injured workers are required to file FL-375.
How to fill out fl-375 - mpiphporg?
FL-375 should be filled out with the provider's information, details of the services provided, and the amount of income received. It must be submitted electronically through the MPN Reporting System.
What is the purpose of fl-375 - mpiphporg?
The purpose of FL-375 is to report income from the MPN to ensure compliance with California's workers' compensation regulations.
What information must be reported on fl-375 - mpiphporg?
Information such as the provider's name, National Provider Identifier (NPI), tax identification number, the date of service, service code, amount billed, and amount paid must be reported on FL-375.
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