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Form 1290, Long Term Care Claim
... claim for tracking and archiving purposes. CMS. Note: Information is entered into CMS exactly as it appears on the ... https://hhs.texas.gov/sites/default/files/documents/laws-regulations/legal-information/ltcbillcodecrosswalk.pdf . ...

Please do not provide personal information (e.g., social security/case numbers, address, etc.)