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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Medicaid Services Completion of this form meets the F22541 (10/2017) requirements and conditions of theCMSapproved Medicaid Waiver programsINCIDENT
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Division of Medicaid Services Completion refers to the form or process required to report Medicaid services provided.
Healthcare providers or facilities that render Medicaid services are required to file Division of Medicaid Services Completion.
Division of Medicaid Services Completion can be filled out online or submitted through designated channels provided by the Medicaid program.
The purpose of Division of Medicaid Services Completion is to ensure accurate reporting of Medicaid services provided for reimbursement purposes.
Information such as patient demographics, services provided, dates of service, and any associated costs must be reported on Division of Medicaid Services Completion.
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