Get the free EXHIBIT 1620-13, ALTCS MEMBER SERVICE PLAN

AHC CCS MEDICAL POLICY MANUAL EXHIBIT 162013, ALTOS MEMBER SERVICE PLAN Members NameAHCCCS ID #Dateset Review Date: (check one)Not to exceed 90 days (HUBS) Not to exceed 180 days (Nursing Facility

How to fill out exhibit 1620-13 altcs member

How to fill out exhibit 1620-13 altcs member

1. To fill out Exhibit 1620-13 ALTCS member, follow these steps:
2. Start by entering the member's personal information, such as their name, date of birth, and contact details.
3. Next, provide details about the member's current living situation, including their address and household composition.
4. Fill in information related to the member's income, including any wages, benefits, or other sources of income.
5. Record the member's assets, such as savings accounts, investments, property, and vehicles.
6. Indicate whether the member has any insurance coverage, including Medicare, Medicaid, or private insurance plans.
7. Provide details about the member's medical conditions, disabilities, and any assistance they require.
8. Finally, review the completed Exhibit 1620-13 ALTCS member form for accuracy and make any necessary corrections before submitting it.

Who needs exhibit 1620-13 altcs member?

1. Exhibit 1620-13 ALTCS member is needed by individuals who are applying for the Arizona Long Term Care System (ALTCS).
2. ALTCS is a Medicaid program that provides long-term care services to eligible Arizona residents who are elderly, disabled, or have certain medical conditions.
3. The exhibit is used to gather information about the member's personal and financial situation, as well as their medical needs, to determine their eligibility for ALTCS benefits.
4. Therefore, anyone who is seeking ALTCS coverage and meets the program's eligibility criteria would need to fill out Exhibit 1620-13 ALTCS member.

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What is exhibit 1620-13 altcs member?

Exhibit 1620-13 altcs member is a form used to report information about members enrolled in the ALTCS program.

Who is required to file exhibit 1620-13 altcs member?

Healthcare providers and facilities participating in the ALTCS program are required to file exhibit 1620-13 altcs member.

How to fill out exhibit 1620-13 altcs member?

Exhibit 1620-13 altcs member can be filled out by providing the requested information about the members enrolled in the ALTCS program.

What is the purpose of exhibit 1620-13 altcs member?

The purpose of exhibit 1620-13 altcs member is to ensure accurate reporting and tracking of ALTCS members for healthcare providers and facilities.

What information must be reported on exhibit 1620-13 altcs member?

Information such as member demographics, eligibility status, covered services, and provider information must be reported on exhibit 1620-13 altcs member.