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Get Wellpoint D0 Payer Sheet Form

Be used for programming the fields and values Express Scripts will accept when processing these claims. Claim transaction segments not depicted within this document may be accepted during the transmission of a claim. However, Express Scripts may not use the information submitted to adjudicate claims. General Information: Payer Name: Express Scripts, Inc. Date: March 1, 2013 Plan Name/Group Name: Express Scripts, Inc. - Standard Plan - Exceptions Noted Processor: Express Scripts, Inc. Switch: E.

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