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Hcfa 1500 Form Aflac. Web definitions & acronyms emergency room (er). Itemized bill if there was a hospital stay (ub04 from the hospital or medical facility) chart note to include admission and discharge paperwork if there was a hospital stay.
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Web life claim forms for the state of illinois must be obtained by contacting aflac worldwide headquarters at 800.992.3522 to have the appropriate forms sent to you. Our customer service representatives are here to assist. Web definitions & acronyms emergency room (er). Web life claim forms for the state of illinois must be obtained by contacting aflac worldwide headquarters at 800.992.3522 to have the appropriate forms sent to you. Definitions & acronyms emergency room (er). C:userse11992appdatalocalmicrosoftwindowstemporary internet filescontent.outlookidimfr14hcfa 1500.xps author: Web what you need to file a claim patient’s name and date of birth. Date and description of injury. Itemized bill if there was a hospital stay (ub04 from the hospital or medical facility) chart note to include admission and discharge paperwork if there was a hospital stay.
