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EXTENDED REPAYMENT PLAN Items included? Yes/No A written request must be submitted that refers to the specific overpayment for which an extended repayment is being requested. This request must detail

How to fill out cms ag 260 form

How to Fill Out CMS AG 260:

1. Begin by obtaining the CMS AG 260 form. This form is used for reporting Medicaid managed care organizations' capitation rate and service delivery for specific populations.
2. Start by filling out the basic information at the top of the form, including the name of the managed care organization, the state, and the reporting period.
3. Next, provide details about the Medicaid managed care organization's administrative structure. This includes information such as the organization's primary address, contact person, and phone number.
4. Proceed to complete the remainder of the form, addressing each section as required. These sections may include aspects such as service delivery, program costs, encounter data, and provider payments. Be sure to carefully read the instructions provided for each section to accurately report the necessary information.
5. As you fill out each section, ensure that all the required data is correctly entered. Double-check for any errors or missing information.
6. Once you have provided all the necessary information, review the form to ensure its completeness and accuracy.
7. After reviewing, sign and date the form as the authorized representative of the Medicaid managed care organization.
8. Keep a copy of the filled-out CMS AG 260 form for the organization's records.

Who Needs CMS AG 260:

1. Medicaid managed care organizations are typically the entities that need to fill out the CMS AG 260 form. These organizations provide managed healthcare services to eligible Medicaid recipients.
2. State Medicaid agencies also require the CMS AG 260 form as a means of assessing and monitoring the performance and financial accountability of Medicaid managed care organizations.
3. The Centers for Medicare and Medicaid Services (CMS) utilize the information reported on the CMS AG 260 form to evaluate and regulate the Medicaid managed care programs, ensuring compliance with federal requirements, and supporting efficient service delivery.

For pdfFiller’s FAQs

What is cms ag 260?

CMS AG 260 is a form used to report certain financial information.

Who is required to file cms ag 260?

Entities specified by the regulatory authority are required to file CMS AG 260.

How to fill out cms ag 260?

CMS AG 260 can be filled out electronically or manually following the instructions provided.

What is the purpose of cms ag 260?

The purpose of CMS AG 260 is to provide financial information to the regulatory authority.

What information must be reported on cms ag 260?

Entities must report specific financial data as specified on the CMS AG 260 form.

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