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4811 fax wwwtditexas.gov MEDICAL FEE DISPUTE RESOLUTION FINDINGS AND DECISION GENERAL INFORMATION Reguestor Name and Address SOUTH TEXAS RADIOLOGY GROUP P 0 BOX 29407 SAN ANTONIO, TX 78229 Respondent Name MITSUI SUMITOMO INSURANCE USA Carrier s Austin Representative Box Box Number 19 MFDR Tracking Number M4-1 1-41 39-01 REQUESTOR S POSITION SUMMARY Reguestor s Position Summary: We originally filed bills to for services performed on the patient. We became aware that we submitted bills.

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