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[DOC File]UB04 Billing Instructions Guide - Maine
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Feb 25, 2021 · Situational (Not required if MaineCare is the only payer). If the patient is covered by insurance under another policyholder, enter the two-digit code to indicate the patient’s relationship to the policyholder. Codes are listed in the National UB-04 Manual. FL 60: INSURED UNIQUE ID. Figure 3 29: FL60 Insured Unique ID. Required

[DOCX File]Maine.gov
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Estate assets can include real property, including jointly owned property, insurance payments, annuities, any property left to an heir, survivor or assignee. No claim will be made if the only benefit service you get is the Medicare Savings Program (Buy-In Program). For more information about the Estate Recovery Program, call 1-800-977-6740.

Sample Employee Handbook.doc - HR 360, Inc.
Dental Insurance. The Company offers a dental plan for eligible employees. Please refer to the dental Summary Plan Description for an explanation of the plan benefits and limitations. Short-Term Disability Plan (STD) A short-term disability plan is provided for eligible full-time employees.

[DOCX File]Family Case Information Statement (CIS)
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The Case Information Statement is a document which is filed with the court setting forth the financial details of your case. The required information includes your income, your spouse's/partner's income, a budget of your joint life style expenses, a budget of your current life style expenses including the expenses of your children, if applicable, an itemization of the amounts which you may be ...

[DOC File]ILLINOIS WORKERS’ COMPENSATION ACT
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Each private self-insurer applying for self-insurance and for renewal of the self-insurance privilege shall pay with its application a non-refundable application fee in the amount of $500, which shall be deposited upon receipt by the Commission into the Self-Insurers Administration Fund and used only for the purposes set forth in this Section.

[DOCX File]IN THE CIRCUIT COURT OF
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Jan 04, 2021 · The parent maintaining coverage shall authorize the other parent to consult with the insurance carrier regarding the coverage in effect. Uncovered reasonable and necessary medical expenses, which may include but is not limited to, deductibles or co-payments, eyeglasses, contact lens, routine annual physicals, and counseling will be paid by

[DOC File]RESEARCH PARTICIPANT CONSENT FORM
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If exposing a subject to radiation, identify the exposure in terms understandable to the participants, such as the amount relative to a routine dental X-ray. If hearing experiments are conducted, compare the noise level to common noises (e.g., the decibel level is comparable to the sound of a vacuum cleaner).

[DOCX File]2020-21 Funding Terms and Conditions - Child …
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Contracts may be fully or partially funded through a grant from the federal Department of Health and Human Services and subject to Code of Federal Regulations (CFR) 45, Parts 98 and 99, the Child Care and Development Block Grant (CCDBG) Act of 1990, as amended by the CCDBG Act of 2014, Public Law 1113-186, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, …

Dental insurance for children only