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1.00PRINTED: 5/15/2017 FORM APPROVED Pennsylvania Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (POC)(XI) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION:

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Who needs xi providersupplierclia?

01

Healthcare providers and suppliers who perform clinical laboratory tests or render diagnostic services.

02

Hospitals, clinics, laboratories, and similar healthcare facilities that offer laboratory testing services.

03

Medical professionals, such as doctors, pathologists, and clinical researchers.

04

Pharmaceutical companies involved in clinical trials and research.

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Home healthcare agencies providing laboratory testing or diagnostic services.

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Entities seeking Medicare or Medicaid reimbursements for laboratory services.

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What is xi providersupplierclia?

Xi providersupplierclia is a form used to report provider or supplier information to a regulatory agency.

Who is required to file xi providersupplierclia?

All healthcare providers and suppliers are required to file xi providersupplierclia.

How to fill out xi providersupplierclia?

Xi providersupplierclia can be filled out online or submitted through mail with the required information.

What is the purpose of xi providersupplierclia?

The purpose of xi providersupplierclia is to ensure regulatory compliance and provide transparency in the healthcare industry.

What information must be reported on xi providersupplierclia?

Information such as provider/supplier name, address, contact information, services provided, and accreditation must be reported on xi providersupplierclia.

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