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Explanation of Benefits EOB Customer service 1-800-123-4567 Statement date XXXXXX Document number XXXXXXXXXXXXXXXXXX THIS IS NOT A BILL Subscriber number XXXXXXXXX Insurance plan logo Member name Address City State Zip ID XXXXXXXXX Group ABCDE Provider Patient name Date received Claim number XXXXXXXXXX Date paid XXXXXXXX 5 Payee What your provider can charge you Claim Detail Paid 31. Contact your health plan if you have questions about your EOB. CMS Product No.11845 Revised September 2016 go....
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