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Please allow 30 days for medical record reviews. Do not attach a copy of the claim form. Please send this form with the. Web complete medical records are not routinely required and should only be submitted when requested. Web ·~ medical record routing form complete this form online and print.
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Web if you're a provider in michigan, find your blue cross blue shield forms, drug lists and medical record retrieval documents. Web ·~ medical record routing form complete this form online and print. Please send this form with the. Please allow 30 days for medical record reviews. Ppo provider preauthorization and precertification requirements (pdf) download.
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Patient information patient name subscriber last. Web the medical record routing form is used to submit required documentation for a previously submitted claim or to link required documentation to an electronically. Ppo provider preauthorization and precertification requirements (pdf) download. Web ·~ medical record routing form complete this form online and print.
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Web complete medical records are not routinely required and should only be submitted when requested. Do not attach a copy of the claim form. Please allow 30 days for medical record reviews.