Get the free MA 11196 NEJE 2012 Coverage Determination Request Form CMS FINAL.doc
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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Coverage Determination/Appeals Department P.O. Box 52000, MC 109 Phoenix, AZ 850722000
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Ma 11196 neje coverage is a form used to report information about certain individuals and their health coverage.
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Employers who provide health coverage to their employees are required to file ma 11196 neje coverage.
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Ma 11196 neje coverage requires information such as the individual's name, social security number, and the type of health coverage they have.
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