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O. Box 61808 Phoenix AX 85082-1808 Attn Cost Containment Grievances and Appeals Or Fax 1-860-607-7657 Please indicate the reason for resubmission and any pertinent details regarding your claim All claims associated with an Itemized Bill must be broken out per Rev Code to verify charges billed on the UB match the charges billed on the Itemized Bill. Review request for a claim whose original reason for denial was duplicate. Refer to Proof of Timely Filing Requirements in your Provider Manual....
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