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FIN593 | 0715HMO/INSURER PROMPT PAY PENALTY REPORTING FORM Prompt Pay Penalty Program Company Name: ___ NAIL#: ___ Reported Month: ___ Report and Payment Due Date: ___ (Due 60 Days after Report Month)
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The kp-0250office of form attorney is a form used to declare and identify an individual or entity as the attorney in fact to act on behalf of another party.
Anyone who is designated as an attorney in fact and has been authorized to act on behalf of another party is required to file the kp-0250office of form attorney.
The kp-0250office of form attorney must be filled out with the relevant information, including the name of the attorney in fact, the name of the party they are authorized to act on behalf of, and the specific powers granted to the attorney in fact.
The purpose of the kp-0250office of form attorney is to formally establish and document the relationship between the attorney in fact and the party they are representing, as well as to outline the specific powers granted to the attorney in fact.
The kp-0250office of form attorney must include the name of the attorney in fact, the name of the party they are representing, the specific powers granted to the attorney in fact, and the effective date of the authorization.
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