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REVENUE RATE CHANGE REQUEST Provider Enrollment Division MS 4704 P.O. Box 997413 Sacramento, CA 958997413 (916) 3231945 Hospital name Provider number Date Address (number, street) City State ZIP code REVENUE
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Revenue rate change request is a formal request submitted to the relevant authority to change the established rate of revenue.
Entities or individuals who want to change the established rate of revenue are required to file a revenue rate change request.
To fill out a revenue rate change request, one must provide relevant information about the current rate of revenue, the proposed change, and any supporting documentation.
The purpose of a revenue rate change request is to request a change in the established rate of revenue for a specific entity or individual.
The revenue rate change request must include details about the current rate of revenue, the proposed change, and any supporting documents or justifications for the change.
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