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Revision: HCFAPM945 (MB) APRIL 1994-Page 19 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAM State/Territory: SOUTH DAKOTA SECTION 3. SERVICES: GENERAL PROVISIONS Citation
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Revision hcfa-pm-94-5 mb page is a form used for updating or correcting information on a healthcare claim.
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On revision hcfa-pm-94-5 mb page, information such as patient details, service codes, diagnosis codes, and any other relevant information must be reported.
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