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Fidel is New Horror INTERNAL USE ONLY Auth #: ___ PaidDeniedPended This claim is for an IHS provider Direct Reimbursement Claim Form Important Information: 1. Use this form to request reimbursement
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Direct online direct reimbursement is a process where employees can submit claims for reimbursement online directly to the insurance company.
Employees who have incurred expenses that are eligible for reimbursement.
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