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Get NM Adjustment/Void Request 2007

field. Adjustment or Void Check the appropriate box. The description of an adjustment and void follows. Adjustment – A request to change information on a paid claim. This may result in a change in payment. Void – A request to recoup the entire payment of a previously paid claim. Provider Information Use either your NPI or NM Medicaid billing provider number and check the box to identify which number you have provided. The box is limited to 10 digits. List your facility name, phone number, a.

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