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Web medical record routing form. Looking for the right form or document to help care for your patients? The medical record routing form is used to submit required documentation for a previously submitted claim or to link required documentation to an electronically submitted original. Complete this form online and print. Web use this form to report these medical conditions:

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You can submit a request again from 8am tomorrow. Open form follow the instructions. Before you begin… only owners, admins, and group admins can create routing forms (but all users can share them!) more on roles can be. Instead of using this form to fax or mail the clinical editing appeal, you can submit.

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Incomplete forms will be returned and may cause a delay in the process. The medical record routing form is used to submit required documentation for a previously submitted claim or to link required documentation to an electronically submitted original. Please allow 30 days for medical record reviews. Web medical record routing form member and provider information member name submission information.

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