Form 404 Request for Administrative Review of Outdated Medicaid Claim - Alabama

Form 404 Request for Administrative Review of Outdated Medicaid Claim - Alabama

What Is Form 404?

This is a legal form that was released by the Alabama Medicaid Agency - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 7, 2020;
  • The latest edition provided by the Alabama Medicaid Agency;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 404 by clicking the link below or browse more documents and templates provided by the Alabama Medicaid Agency.

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Download Form 404 Request for Administrative Review of Outdated Medicaid Claim - Alabama

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