Provider's Request for Adjustment


Document Information
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Title Provider's Request for Adjustment
Description

Providers use this to report total overpayment, partial overpayment and/or underpayment by L&I.

Document number F245-183-000
How to get this document
Keywords adjustment form, adjustments, billing errors, bills, medical services, provider
Alt Language(s)
Valid dates 01/2014, 11/2013
Contact information Managing Injured Workers' Claims
Websites For Medical Providers

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