Get the medicaid alabama services claim refund form

Description of Alabama
Check Refund Form REF-02 Mail To HP Refunds P. O. Box 241684 Montgomery AL 36124-1684 Provider Name NPI Number Check Number Check Date Check Amount Information needed on each claim being refunded Claim 1 13-digit Claim Number f rom EOP Recipient s ID Number from EOP Recipient s name Last First Date s of service on c laims Date o f Medicaid pa yment Service being refunded Amount of refund Amount of insurance...
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