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Get F245-046-000 - IME Provider Account Application

U will find the Independent Medical Exam (IME) Provider Account Application. To receive payment, you must be approved as an IME Provider and be assigned an IME provider account number. Practitioners, please submit the following documents: Application (2 pages) Signed and dated attestation Provider agreement (2 pages) IME Provider Exam Sites Statewide Payee and W-9 Certificate of successful completion of the Medical Examiners Handbook test Current copy of the provid.

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