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Get Tenncare Subrogation

Ease Form Please allow 10 business days for an initial response and up to a maximum of 120 days for a complete response. TCA 71-5-117(g) 1. PATIENT INFORMATION: FULL NAME: DATE OF BIRTH: SSN: - - TennCare or MCO ID#: MCO Name: 2. ACCIDENT or ILLNESS INFORMATION: DATE of ACCIDENT or ILLNESS:.

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