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Get Blank Hcif 2007-2024

Is accepted for processing after May 24, 2007. The fields listed below are used by EDS when processing Ladies First claims. The fields designated by an Asterisk (*) are mandatory; other fields are required when applicable. To Process LF Electronic 837 Claims Populate the special program code with a value of 03 to indicate it is a Ladies First claim. FIELD LOCATOR REQUIRED INFORMATION 1. CARRIER IDENTIFICATION Check the Other box. 1a. INSURED'S ID NUMBER* Enter the nine-digit social.

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