|Classification / Identification:|
| ||Form Number:||014-2404-84||Edition date: ||2020/03 |
| ||Title:||Claims Flagged for Manual Review|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Claim Services Branch|| || |
| ||Program:||Claims Services|| || |
| ||Purpose of Form:||form submitted with claims to provide additional information regarding particular claim|| || |
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