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Get and Sign Network Health Admission Surgery Notification Form 2009-2022

Get and Sign Network Health Admission Surgery Notification Form 2009-2022

Use a notification form 2009 template to make your document workflow more streamlined.

Phone - - Fax Network Health provider ID # or billing ID # - - Tax ID # Member diagnosis with ICD-9 code Procedure performed with CPT code Hospital name Length of stay Hospital ID # Hospital tax ID # Floor/room number UR phone - - Contact name Contact phone - - Contact fax - - Hospital address City 06159 Network Health Provider Manual 2009 State Form available at www.network-health.org ZIP Attachment E Phone:...
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