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HELPING GOVERNMENTSERVE THE PEOPLED HCS HBO 117044January 10,2011Ms. Maria Enriquez, Chief Department of Health Care Services Fiscal Intermediary & Contracts Oversight Division MS4700 P.O. Box 997413
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What is cops-172 disenrollment sum?
cops-172 disenrollment sum is a form used to report disenrollment information for individuals from a plan.
Who is required to file cops-172 disenrollment sum?
Health plans are required to file cops-172 disenrollment sum.
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cops-172 disenrollment sum can be filled out electronically or manually with the required information on disenrolled individuals.
What is the purpose of cops-172 disenrollment sum?
The purpose of cops-172 disenrollment sum is to provide accurate data on individuals who have disenrolled from a plan.
What information must be reported on cops-172 disenrollment sum?
Information such as member name, member ID, disenrollment date, reason for disenrollment must be reported on cops-172 disenrollment sum.
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