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This document outlines the Medicaid managed care program in North Carolina, detailing enrollment processes, provider responsibilities, and program management under the social security act.
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How to fill out cms-pm-10120 - ncdhhs
How to fill out CMS-PM-10120
01
Begin by gathering necessary personal information, including your full name, address, and contact details.
02
Indicate your social security number or other identification number as required.
03
Fill out the section related to your health insurance coverage, including policy numbers and provider details.
04
Provide detailed information about your medical history as prompted in the form.
05
Review the form for accuracy and completeness before submitting.
06
Sign and date the form where indicated to validate your submission.
Who needs CMS-PM-10120?
01
Individuals applying for Medicare services or benefits.
02
Healthcare providers submitting claims for Medicare patients.
03
Administrators or coordinators managing patient records within healthcare facilities.
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What is CMS-PM-10120?
CMS-PM-10120 is a form used by healthcare providers to report information related to provider enrollment, such as Medicare and Medicaid participation.
Who is required to file CMS-PM-10120?
Healthcare providers and suppliers who wish to enroll in Medicare or Medicaid programs are required to file CMS-PM-10120.
How to fill out CMS-PM-10120?
To fill out CMS-PM-10120, providers must provide accurate information about their practice, including their National Provider Identifier (NPI), office address, and ownership details, following the instructions provided with the form.
What is the purpose of CMS-PM-10120?
The purpose of CMS-PM-10120 is to collect necessary data for the enrollment and revalidation process for healthcare providers participating in Medicare and Medicaid programs.
What information must be reported on CMS-PM-10120?
The information that must be reported on CMS-PM-10120 includes provider demographics, taxonomy codes, practice locations, and any pertinent ownership and controlling interest information.
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