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Get IA 470-4698 2019

S. Case Manager (CM) Service Programs Medicaid Member Reporting Party Provider/Facility Information Incident Status: Initial (pending further investigation) Completed (investigation completed) Additional information added Managed Care Organization: Amerigroup Iowa UnitedHealthcare Community Plan Iowa Total Care Non-MCO Phone Number National Provider Identifier Provider or Agency Name Provider Address City State Reporter’s First Name Last Name Zip Code Title Email Phone Number Po.

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