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Coordination of Benefits Form Letter

Coordination of Benefits Form Letter

Use a coordination of benefits letter to patient 0 template to make your document workflow more streamlined.

Without COB delays please complete the following information within 10 business days and return it to us at the following address Magellan Behavioral Health P. Please indicate the name of the carrier and effective date Carrier Effective date If you are married is your spouse employed Yes No If yes name of spouse s employer Spouse s date of birth Does your spouse have group coverage through his/her employer Yes No If yes complete section 11. If so is your spouse covered as an active employee or...
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