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Medical Fee Dispute Resolution Findings and Decision
General Information
Requestor Name
PEAK INTEGRATED HEALTHCARERespondent Name
AMERICAN CASUALTY COMPANYMFDR Tracking Number
M422226001Carriers Austin
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What is box number 57?
Box number 57 is a specific box on a form where certain information needs to be reported.
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Individuals or entities who meet certain criteria outlined by the form instructions are required to file box number 57.
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