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Form CMS-10003 Notice of Denial of Medical Coverage
Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)
CMS-10003_NDMCP_Notice of Denial of Medical Coverage or Payment_2020_v508
Notice of Denial of Medical Coverage (or Payment)
OMB: 0938-0829
OMB.report
HHS/CMS
OMB 0938-0829
ICR 202303-0938-003
IC 8626
Form CMS-10003 Notice of Denial of Medical Coverage
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0829 can be found here:
2024-09-19 - Revision of a currently approved collection
2023-08-08 - Extension without change of a currently approved collection
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