Travel Reimbursement Request (F245-145-000)
Aug 08, 2016 · F245-145-000 Travel Reimbursement Request 09-2019 . After the first visit for your claim, travel is only payable if you: • Have authorization from your claim manager and • See a provider who’s in the L&I Provider Network (exceptions may apply see link below). Instructions: Complete each column. • Column A: Date you traveled (one date ...
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