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Get Provider Inquiry Claim Form 470 3744

Iowa Department of Human Services Iowa Medicaid Program PROVIDER INQUIRY Please check the type of inquiry below Inquiry about payment or medical determination of a specific claim TCN below General Issue regarding Medicaid policy an example TCN may be reference below Attach supporting documentation. Check applicable boxes Claim form Remittance copy Other pertinent information for possible claim reprocessing 1. 17-DIGIT TCN Required if about a spec.

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Keywords relevant to Provider Inquiry Claim Form 470 3744

  • reprocessing
  • remittance
  • applicable
  • IA
  • medicaid
  • pertinent
  • documentation
  • provider
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