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Hearing Services Program claim for payment form

Providers can use this form to claim reimbursement for Hearing Services Program services and devices, when they can’t make a portal claim or e-claim.

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Hearing Services Program claim for payment form

Hearing Services Program claim for payment form – example

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Publication date:
Last updated:
Publication type:
Form
Audience:
Health sector
Language:
English
Description:

This form is mandatory for all manual claims. Keep a copy of the completed claim form on the client’s record.

Part of a collection:
Hearing Services Program provider resource collection
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