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SECTION500 REPORTINGINSTRUCTIONS DENIALSREPORTRevised04/16/15 OverviewTheHSCRCiscollectingdataonhospitalservicesforwhichthirdpartypayersrefused paymentandthepaymentandwaswrittenoffasadenial. ThisinformationwillassisttheCommissionin

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Start by locating the numberasformmainidentifierformreportingperiodandformreportnamee form.

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Enter the main identifier in the designated field on the form. This identifier helps identify the specific report being filled out.

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Provide the reporting period for the report. This could be a specific time frame or a specific event, depending on the nature of the report.

04

Fill in the form report namee. This could be a descriptive name that summarizes the contents of the report.

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The numberasformmainidentifierformreportingperiodandformreportnamee is a unique identification code for a specific reporting form.

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