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STATEMENT OF INTENT TO RETURN HOME Applicant/Recipient s Name: Instructions: Record the applicant/recipient s (or his representative s) responses to the following questions and have him sign the form.

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What is dma-5159 - nc dhhs?

dma-5159 - nc dhhs is a form used by the North Carolina Department of Health and Human Services to report Medicaid claims data.

Who is required to file dma-5159 - nc dhhs?

Healthcare providers who submit Medicaid claims in North Carolina are required to file dma-5159 - nc dhhs.

How to fill out dma-5159 - nc dhhs?

dma-5159 - nc dhhs can be filled out electronically or manually by providing details of Medicaid claims data as per the instructions provided.

What is the purpose of dma-5159 - nc dhhs?

The purpose of dma-5159 - nc dhhs is to collect and analyze data related to Medicaid claims in order to ensure accurate reimbursement and program integrity.

What information must be reported on dma-5159 - nc dhhs?

Information such as patient details, services provided, provider information, billing codes, and reimbursement amounts must be reported on dma-5159 - nc dhhs.

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