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Table of Contents State/Territory Name:Wist ate Plan Amendment (SPA) #: 180005 This file contains the following documents in the order listed: 1) Approval Letter 2) CMS 179 Form/Summary Form (with
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2 cms 179 formsummary is a form used for reporting information related to healthcare services.
Healthcare providers and organizations are required to file 2 cms 179 formsummary.
2 cms 179 formsummary can be filled out electronically or manually, following the instructions provided by the CMS.
The purpose of 2 cms 179 formsummary is to collect data on healthcare services provided and payments received.
Information such as patient demographics, services provided, and payment details must be reported on 2 cms 179 formsummary.
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