SAMPLE RESPIRATORY PROTECTION PROGRAM AS PER …

Providers without electronic billing capability must mail the appropriate National Standard Claim Form (CMS-1500 or CMS-1450) to DXC Technology, PO Box 34440, Little Rock, AR 72203. (See Section V of this manual for examples of CMS-1500 and CMS-1450).). Along with the National Standard Claim Form, providers must submit attachment DMS-600. ................
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