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NC Division of Medical Assistance Program of All-Inclusive Care for the Elderly (PACE) Medicaid and Health Choice Clinical Coverage Policy No: 3B Revised Date: March 12, 2012, Table of Contents 1.0
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How to fill out nc dma 3b pace
How to fill out NC DMA 3B PACE:
01
Familiarize yourself with the form: Read through the instructions and understand the purpose of each section.
02
Provide personal information: Fill in your name, address, date of birth, social security number, and any other required identification details.
03
Specify the program: Indicate the specific PACE program for which you are applying or renewing.
04
Income and resource information: Provide accurate details about your income, assets, and resources. This may include information about your wages, pensions, investments, and real estate.
05
Medical information: Include relevant medical details such as diagnoses, disabilities, and prescriptions. Mention any specialized care or treatments that you require.
06
Personal care needs: Describe your daily activities and the assistance you need with tasks such as bathing, dressing, and eating.
07
Physician's certification: Have your primary care physician or another medical professional complete the certification section of the form, confirming your eligibility for the PACE program.
08
Sign and date: Affix your signature and the date on the designated areas of the form.
09
Submit the form: Send the completed NC DMA 3B PACE form to the appropriate address mentioned in the instructions.
Who needs NC DMA 3B PACE:
01
Individuals seeking enrollment or renewal in a PACE program in North Carolina.
02
Those who are elderly or have disabilities and require comprehensive medical care and support services.
03
Individuals who meet the eligibility criteria of the NC DMA 3B PACE program, which may include age, medical condition, and income requirements.
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What is nc dma 3b pace?
The NC DMA 3B PACE is a form used by the North Carolina Department of Medical Assistance (DMA) to gather information from providers participating in the Programs of All-Inclusive Care for the Elderly (PACE) program.
Who is required to file nc dma 3b pace?
Providers participating in the PACE program in North Carolina are required to file the NC DMA 3B PACE form.
How to fill out nc dma 3b pace?
To fill out the NC DMA 3B PACE form, providers must provide accurate and complete information about their participation in the PACE program, including financial data, participant demographics, and healthcare services provided.
What is the purpose of nc dma 3b pace?
The purpose of the NC DMA 3B PACE form is to collect data and monitor the performance of providers participating in the PACE program in North Carolina. It helps the DMA assess the quality of care, utilization of services, and financial aspects of the program.
What information must be reported on nc dma 3b pace?
The NC DMA 3B PACE form requires providers to report information such as participant demographics, enrollment and disenrollment data, provider services and reimbursements, financial statements, and compliance with program requirements.
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