CMS 1500 (formerly L&I Health Insurance Claim form)

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Title CMS 1500 (formerly L&I Health Insurance Claim form)

Used by providers to be reimbursed for services. It is NOT for use by injured workers to submit a claim to L&I.

Document number F245-127-000
How to get this document
Alt Language(s)
Valid dates 08/2005
Contact information Claims for Job Injuries, Employer Services
Websites For Medical Provider

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