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Medicaid Claim Form for Electronic Billing
MEDI-CAL ICD10 BLANK
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Sample Paper Billing Medicaid Form for 92340 - 92371
Medicaid Claim Form for Electronic Billing
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STEP ONE
ETIN Request Forms
FINAL STEP
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J. Sklar Computers, Inc. Medical Billing Service
Office Phone #: (516) 791-5630
Office Fax# : (516) 568-7813
P.O. Box 340, Valley Stream NY 11582
These forms must be ordered directly from Medicaid. Please call 1 (800) 343-9000 to request these forms.
medicaid_paper_billing_for_92340-92371.pdf
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