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Rpayments involving Medicare Secondary Payer. Please include any supporting documentation such as a corrected claim or for MSP a copy of the primary insurance explanation of beneits. Date State KY Fax 1.615.664.5916 (KY) 1.615.664.5926 (OH) Note Please transmit one fax per NPI number. OH Supplier Information Contact Name NPI PTAN Street Address City State Zip State Zip Beneiciary Information Beneiciary Name Medicare Number Street Address City Claim Information (for each claim ple.

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