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Get ADA J-400 2012-2024

number. Claims submitted with missing or invalid required fields may be rejected and/or returned for correction and resubmission. Note: Please do not include any type of attachment (e.g., X-rays, dental records, accident reports), except Federal Employee Program (FEP) dental injury claims. If additional information is required to process the claim, we will send you a request. Requirements Required Field Description 1: Type of Transaction Show the type of transaction applicable to this claim by.

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