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If you experience difficulties with submitting your comments via this method, please be assured that comments received via all methods are given equal consideration. In addition to the regular mail, you may submit comments via e-mail and by FAX (see end of form below). If you do experience difficulty with submitting this form, please include on your comments submitted by an alternate method the following information: Name of contact person, phone number and e-mail address, and a description of the problem including any error messages received.

     
Draft Local Coverage Determinations Comment Form
(Enter Your Information, Comments, And Press Submit Button)
(fields marked with an * are required)
(*) Name And Title:

Provider Number:

(*) Address:

(*) City:

(*) State:

(*) Zip:

Fax #:

Tele #:

Extension:

(*) Your E-Mail Address? (Required For A Response/Confirmation)

Draft LCD Number:

(*) Draft LCD Title:

(*) Your Comments?

Pasting your comments in from Microsoft Word? Before you do, please do the following steps:

1. Spellcheck your document.
2. Do a “save as” in Word.
3. In the “save as type” dropdown, select “MS-DOS text”.
4. Save to location of choice. File will be saved with a .TXT extension.
5. Open up the .TXT file you just saved.
6. Copy & paste into comment textarea input box below.

 

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Comments may also be directed in writing to:

Medical Policy Department
Highmark Medicare Services
Fifth Avenue Place, Suite P5101
120 Fifth Ave.
Pittsburgh, PA 15222


By Fax: (412) 544-1971

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