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State of California Health and Human Services Agency Department of Health Care Services PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN PROVIDER FACT SHEET What is Presumptive Eligibility (PE) for Pregnant
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What is form presumptive eligibility provider?
Form presumptive eligibility provider is a document used to determine if an individual meets the eligibility requirements for certain benefits before a formal eligibility determination is made.
Who is required to file form presumptive eligibility provider?
Healthcare providers who are enrolled in a presumptive eligibility program and wish to provide temporary Medicaid coverage for eligible individuals.
How to fill out form presumptive eligibility provider?
The form should be filled out by the healthcare provider, providing all required information such as the individual's personal details, income information, and any other relevant details.
What is the purpose of form presumptive eligibility provider?
The purpose of form presumptive eligibility provider is to expedite the process of determining eligibility for certain benefits, allowing eligible individuals to receive temporary coverage while their eligibility is being formally evaluated.
What information must be reported on form presumptive eligibility provider?
The form should include the individual's personal information such as name, address, date of birth, income details, and any other required information determined by the program.
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