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Get Form Dms 694

CODE DMS-694 Rev. 10-99 BILLING DATE 27 OR UNITS TOS PERFORMING FOR OFFICE USE 28 TOTAL CHARGES COVERED BY INSURANCE PROVIDER S SIGNATURE CHARGES BALANCE DUE Instructions for Completion of the EPSDT Claim Form DMS-694 EDS offers providers several options for electronic billing. To bill for a Child Health Services EPSDT screening service use the claim form DMS-694. The numbered items correspond to numbered fields on the claim form. The DMS-694 is.

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