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Formal Administrative Claim Appeal Date: Claim Information:Requestor/Responder Information:Claim#:Name: Member Name: Contact#: Member ID#: Fax#: Date of Service: Address: Date of EOB: Type of Claim:
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NPDB Guidebook Chapter E covers reporting requirements for Medical Malpractice Payment Reports.
Healthcare entities and medical malpractice payers are required to file NPDB Guidebook Chapter E.
NPDB Guidebook Chapter E can be filled out online through the NPDB website or through an authorized reporting entity.
The purpose of NPDB Guidebook Chapter E is to ensure transparency and accountability in the healthcare system by reporting medical malpractice payments.
Information such as the date of payment, amount of payment, and the reason for the payment must be reported on NPDB Guidebook Chapter E.
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