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  • Icon ADA Dental Claim Form
    Icon Chemical Dependency Treatment Plan Review Request
    Icon HCFA 1450 (UB92) Claim Form
    Icon HCFA 1500 Claim Form
    Icon Mental Health Outpatient Treatment Plan Review Request
    Icon Oregon Practitioner Credentialing Application
    Icon Preauthorization Request Form – Behavioral Health
    Icon Preauthorization Request Form - Idaho
    Icon Preauthorization Request Form - Oregon

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