Document

Submission Form for Other Payer Requests for Other Payer Advanced APM Determinations (Payer Initiated Submission Form)

ICR 202007-0938-007 · OMB 0938-1314 · Object 103040601.

Document Viewer [pdf]

Status: Original and derived artifacts are available for this document.

Download: pdf

Primary: pdfSource: application/octet-stream
Loading document viewer…
Document Metadata
File Typeapplication/octet-stream
File TitleSubmission Form for Other Payer Requests for Other Payer Advanced APM Determinations (Payer Initiated Submission Form)
AuthorCMS
File Modified2020-08-03
File Created2020-08-03
Conversion Statecomplete