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MANDATORY CHECK LIST FOR SUBMISSION OF MEDICAID REIMBURSEMENT CLAIM FORM Arrange the documents in same ORDER as in the checklist so that you have not missed any documents INSURED NAME Policy No. PATIENT
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What is copy of check list?
Copy of check list is a duplication of the original checklist document.
Who is required to file copy of check list?
The party responsible for completing the checklist is required to file a copy of it.
How to fill out copy of check list?
The copy of the checklist should be filled out with the same information as the original checklist.
What is the purpose of copy of check list?
The purpose of the copy of the checklist is to keep a duplicate record for reference or documentation purposes.
What information must be reported on copy of check list?
The copy of the checklist must contain all the same information as the original checklist, including items checked off and any notes or comments.
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