470 2486-2025

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4.9 out of 5

496 votes

The document is a claim form for targeted medical care provided by the Iowa Department of Human Services. It includes sections for member and provider information, details about services rendered, and certification statements regarding the accuracy and necessity of the claims. The form also outlines compliance with Medicaid program requirements and provides place of service codes.

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Versions	Form popularity	Fillable & printable
2008	4.9 Satisfied (496 Votes)

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