Claim correspondence

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Non-Minnesota Providers

Minnesota Providers

Provider information

* Provider name

* Tax ID NPI

* First name

* Last name

* Phone #

Ext.

Fax #

* Email

* Product type

HealthPartners Commercial products HealthPartners Government and Senior products HealthPartners Dental

* Member first name

* Member last name

* Member #

Claim #

* Date of service

* Billed charges

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