CMS-10791- PPDR-Payment Settlement Form Notice

No Surprises Act: IDR Process

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0169 can be found here:

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File Type	application/pdf
File Title	10. PPDR - Payment Settlement Form
File Modified	2021-12-19
File Created	2021-12-11