Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities

No Surprise 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⚠️ Notice: This form may be outdated.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/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	10. PPDR - Payment Settlement Form
Author	LAURA BYABAZAIRE
File Modified	0000-00-00
File Created	2023-08-30