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22627ELECTRONIC DATA
INTERCHANGE (EDI) Enrollment fields marked with * are required and must be completed. Reference Materials are available on the last page of this document. Apart A (Institutional)
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Part B professional refers to a section of a form or document that pertains to information related to a person's professional activities or services.
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The purpose of part B professional is to document and disclose relevant information about the professional activities or services being provided.
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Information that must be reported on part B professional may include details about the services provided, fees charged, clients served, etc.
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