Transcription of General Information for Authorization
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General Information for Authorization
General Information for Authorization Org 1.
The name of the billing/servicing provider. ... (Refer to the program specific Medicaid Provider Guide for the appropriate unit/day designation for the service code entered). 24 ... Must be entered in dollars & cents with a decimal (e.g. $400 should be entered as 400.00). 25 Part # (DME only): (Required for all requested codes). Enter the ...
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