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Nds, Albany, N.Y. 12241, when the following conditions exist: A. The medical bill(s) originally submitted on Form C-4 (for hospitals, Form UB-92) or HCFA-1500 to the responsible insurance carrier or self-insured employer relates to service(s) rendered on or after October 1, 1994; or for inpatient hospital bills with a discharge date on or after 12-31-96 (for inpatient services with a discharge date prior to 12-31-96 contact your appropriate Dispute Resolution Agent); AND B. The fee(s) billed is.

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