This Medicaid Claim Form is available in a 2-part carbonless snap-apart format. This form has been already approved by Medicare and Medicaid for insurance claims.
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Medicaid Claim Form 2 Part
From:
$58.00
Weight
5 lbs
Dimensions
1 × 2 × 3 in
Quantity
250, 500, 1000
Paper Type
2 part (white-yellow)
Dec 03, 2012
Brooke F.
It would be nice to not be charged until after an e-mail with a proof was sent and agreed upon.
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