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Get NJ 2642 (W0208)

Ust be submitted indicating the expected length of time the equipment will be in use. If renting, please have your medical equipment supplier also indicate the purchase price of the equipment on the bill. Foreign Claim? Bills for services incurred outside of the U.S. must include an English translation and the exchange rate at the time of services. If you have any questions about how to submit your Claims, please call the Customer Service # 1-800-414-SHBP (7427). WHERE TO SUBMIT YOUR CLAIM FORM.

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