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Final Settlement Detail Document Form

Final Settlement Detail Document Form

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Amount Additional Procurement Expenses Please submit an itemized listing of these expenses Date the Case Was Settled Settlement Information Provided By Date The completed form should be sent to Medicare Secondary Payer Recovery Contractor NGHP PO Box 138832 Oklahoma City OK 73113 If you have any questions concerning this matter please call the Medicare Secondary Payer Recovery Contractor MSPRC at 1-866-677-7220 TTY/TDD 1-866-677-7294 for the hearing and speech impaired or you may contact us in...
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