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Documentation from the medical record must include Required Documents Evidence that the member was dispensed a DMARD during 2017 on an outpatient basis during 2017 drug manufacturer. BestPractice Quality Dispute Form/Secondary Insurance Fax 716 887-7967 Anti-Rheumatic Drug Therapy ART Provider Information Provider Name Address Specialty NPI Tax ID Contact Name Contact Phone Patient Information Patient Name DOB BlueCross BlueShield Insurance Primary Secondary ID Measure/Description Patients...
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