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Patient Provider Dispute Resolution Initiation Form
ICR 202508-1210-009 · OMB 1210-0169 · Object 164277100.
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Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | Patient Provider Dispute Resolution Initiation Form |
| Subject | patient provider dispute resolution form, PPDR form, billing dispute form, mail-in billing dispute form, payment dispute, medica |
| Author | CMS |
| File Modified | 2021-12-29 |
| File Created | 2021-12-21 |
| Conversion State | complete |