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Get the free Procedure 18-4: Completing a CMS-1500 (08-05) Claim Form

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Part II Blank Forms 557 CARRIER 1500 HEALTH INSURANCE CLAIM FORM APPROVED BY NATIONAL UNIFORM CLAIM COMMITTEE 08/05 PICA (Medicare #) MEDICAID (Medicaid #) TRI CARE CAMPUS (Sponsor s SSN) CHAM PVA
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YY INSUREDS NPI SSN FECA NUCC CHAMPUS LMP EIN a-d MODIFIER 24E OMB-0938-0999 17a BLK RESUBMISSION CMS-1500 EMG D4477 CHAMPVA EPSDT indb 17b TRICARE 10d HCPCS govt QUAL PICA CPT

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