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PLEASE DO NOT USE STAPLES FOR ANY DOCUMENTATION Medicare Secondary Payer Inquiry Form ALL ends are REQUIRED. For your convenience, please complete this form and mail to the address at the bottom.
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2016 MSP MS-RRB-B-3000 ESRD OIG ICD-9 EOB PTAN Reopenings Redetermination BCRC benets specic elds NPI ICN Overpayment CPT Payer HIC submissions applicable utilized Medicare STAPLES pertaining submission appropriately timely Revised DOCUMENTATION

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