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The following forms may be required in conjunction with a claim. Providers can order CMS-1500 (professional), ADA 2012 (dental) and UB-04 (institutional) claim
Apr 1, 2022 HOSPICE CAP RATE DATA REQUEST FORM. 2 Peachtree Street NW 39th Floor Free Standing Rural Health Clinic. $2.00. Home Health Services. $3.00.
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