TN 7 (07-95)

NL 00722.007 Form CMS-L1626-TR Notice of Group Billing Arrangement

A. POLICY

The Office of Systems prints and releases this notice to a beneficiary when a third party group payer has agreed to pay SMI premiums.

B. EXHIBIT — FORM HCFA-L1626-TR

 

G-HCFA-L1626-TR

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722007
NL 00722.007 - Form CMS-L1626-TR Notice of Group Billing Arrangement - 05/08/2008
Batch run: 01/27/2009
Rev:05/08/2008