Check Refund Form (providers only)

Medicaid Agency

This government document is issued by Medicaid Agency for use in Alabama

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File Details: PDF (76.8 KB)
Downloads: 68
Source
https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.2_Billing_Forms/9.4.2_Form_REF-02_ADM_Check_Refund_Request_3-16-16.pdf

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