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This document outlines the requirements and structure for North Carolina's Medicaid managed care program, detailing enrollment processes, provider relationships, and public involvement in the program.
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How to fill out cms-pm-10120 - ncdhhs
How to fill out CMS-PM-10120
01
Begin with Section A: Enter the patient's personal information including name, date of birth, and Medicare number.
02
Move to Section B: Provide the provider's details including name, address, and National Provider Identifier (NPI).
03
In Section C, input the diagnosis codes that are relevant to the patient's condition.
04
Next, complete Section D by listing the dates of service and the type of services provided.
05
Proceed to Section E: Indicate any additional services requested or needed.
06
Finish with Section F: Sign and date the form, ensuring all information is accurate before submission.
Who needs CMS-PM-10120?
01
Healthcare providers who are seeking reimbursement for services provided to Medicare beneficiaries.
02
Patients who require prior authorization for specific medical services or treatments covered by Medicare.
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What is CMS-PM-10120?
CMS-PM-10120 is a form used by healthcare providers to report specific data related to Medicaid and Children's Health Insurance Program (CHIP) services.
Who is required to file CMS-PM-10120?
Healthcare providers participating in Medicaid or CHIP programs are required to file CMS-PM-10120 to ensure compliance with federal and state reporting requirements.
How to fill out CMS-PM-10120?
To fill out CMS-PM-10120, providers should collect the necessary data regarding services provided, complete the form according to the instructions provided, and submit it to the appropriate state Medicaid agency.
What is the purpose of CMS-PM-10120?
The purpose of CMS-PM-10120 is to collect data on Medicaid and CHIP services that allows for monitoring, evaluation, and quality improvement of healthcare services.
What information must be reported on CMS-PM-10120?
CMS-PM-10120 requires reporting information such as provider details, types of services rendered, patient demographics, and any other relevant data as specified in the form instructions.
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