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Submitting an EC-4NARR Form For a Patient

Adding Billing Information

Complete section D. Billing information. You may add additional ICD9 codes by selecting the "Add Another ICD9 Code" button and as many billing rows as needed by selecting "Add Another Billing Row".

You may remove the last ICD9 code in the list by selecting the "Remove Last ICD9 Code" button and the last billing row by selecting "Remove Last Billing Row".

A minimum of one ICD9 code and one billing row is required information to be provided on the form.