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OVERPAYMENT NOTIFICATION FORM GENERAL INSTRUCTIONS FOR PROVIDERSThis form is for use by providers when an overpayment is being returned and/or action is being requested by Premiere Blue Cross Blue
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What is this form is for?
This form is for reporting financial information.
Who is required to file this form is for?
Entities that meet certain criteria set by the governing body.
How to fill out this form is for?
The form can be filled out electronically or manually.
What is the purpose of this form is for?
The purpose of this form is to provide transparency and accountability.
What information must be reported on this form is for?
Information related to the financial activities of the entity.
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