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Nalc prior authorization form

Nalc 200 forms 2025

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The document is a Health Insurance Claim Form specifically for providers enrolled with the Office of Workers' Compensation Programs (OWCP) under Provider Type 95. It outlines the necessary information required for processing claims, including patient details, diagnosis and procedure codes, service dates, charges, and provider information. Accurate completion of the form is essential to avoid delays in reimbursement.

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