Free D-53 - Nevada


File Size: 7.4 kB
Pages: 1
Date: June 19, 2009
File Format: PDF
State: Nevada
Category: Workers Compensation
Author: jdenison
Word Count: 50 Words, 295 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dirweb.state.nv.us/Forms/d-53.pdf

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SPECIAL NOTE REGARDING D-53, UB-04 See message from Centers for Medicare & Medicaid Services: "Both forms [CMS 1500 & 1450] must be purchased; we do not make these forms available for download due to specific requirements. CMS-1500 you can call 202-512-0224 CMS-1450 you can call 800-755-6405"