Sbr 1 2012 form-2025

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The document outlines the process for medical providers in California to request a second bill review for denied or adjusted medical charges related to workers' compensation claims. It includes sections for employee, provider, and claims administrator information, as well as details on disputed services and required documentation. The instructions specify how to apply for the review, the timeline for submission, and the necessary information to include in the request.

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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (243 Votes)
2012	4.3 Satisfied (236 Votes)

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