MA MassHealth EOM 10-06 2010-2025 free printable template
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Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth Eligibility Operations Memo 10-06 April
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How to fill out MA MassHealth EOM 10-06
01
Begin by obtaining the MA MassHealth EOM 10-06 form.
02
Fill in the patient’s information, including name, address, and MassHealth identification number.
03
Provide the date of service and the type of service provided.
04
Enter the relevant diagnostic codes as applicable to the services rendered.
05
Include the provider's information, such as name, address, and provider number.
06
Ensure to sign and date the form at the designated area.
07
Submit the completed form to the appropriate MassHealth office.
Who needs MA MassHealth EOM 10-06?
01
Individuals applying for or currently enrolled in MassHealth who require comprehensive medical coverage.
02
Healthcare providers seeking reimbursement for services provided to MassHealth members.
03
Social workers or case managers assisting clients with filling out health care forms.
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What is MA MassHealth EOM 10-06?
MA MassHealth EOM 10-06 is an electronic form used for reporting certain participant details and eligibility for the Massachusetts Medicaid program, known as MassHealth.
Who is required to file MA MassHealth EOM 10-06?
Providers who are billing MassHealth for services rendered to members must file the MA MassHealth EOM 10-06 form.
How to fill out MA MassHealth EOM 10-06?
To fill out MA MassHealth EOM 10-06, follow the instructions provided on the form, ensuring all required fields are completed accurately with the appropriate participant and service information.
What is the purpose of MA MassHealth EOM 10-06?
The purpose of MA MassHealth EOM 10-06 is to ensure correct billing and reporting of services provided to MassHealth members, helping to maintain accurate records for reimbursement.
What information must be reported on MA MassHealth EOM 10-06?
The MA MassHealth EOM 10-06 form requires reporting of participant demographic information, service details, dates of service, and any applicable billing codes.
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