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E-MEDICAL
BILLING SERVICES, LLC |
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Doctor’s Office:_________________________ Date:
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Pt Name: ______________________________ Pt Chart:
_______________________________
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Date Returned to Client: _________________
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| We need additional information from your office in order to complete the following claim submission. To avoid a delay in timely filing please complete and return ASAP along with the attached Superbill. We cannot be held responsible for any charges sent to our office beyond the timely filing period. | |||||||||||||||||||||
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| Thank you for your cooperation, if you have any questions please feel free to contact us. | |||||||||||||||||||||
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Sincerely,
Susan I. Rothwell E-Medical Billing Services Business Manager |
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