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Applied Behavior Analysis (ABA) Service Request Form This is a request for medical necessity determination. It does not confirm benefits and eligibility. Provider must call BCB SIL at 8008517498 to
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It does not confirm is a form used to deny or refute a claim or statement.
Any individual or entity who needs to officially deny or negate a claim or statement.
The form should be completed by providing a detailed explanation or evidence to refute the claim.
The purpose is to officially deny or disprove a claim or statement.
Details explaining why the claim is being denied or refuted.
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