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DEPARTMENT OF HEALTH SERVICES Division of Medicaid ServicesSTATE OF WISCONSINF01812 (9/2018)WISCONSIN MEDICAID PROGRAM 2018 NURSING HOME COST REPORT Completion of this form is required by Section
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How to fill out nursing home reimbursementwisconsin department

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How to fill out nursing home reimbursementwisconsin department

01
Obtain the necessary forms from the Wisconsin Department of Health Services website or by contacting their office.
02
Fill out the personal information section, including your name, address, and contact details.
03
Provide the details of the nursing home where you or your loved one received care, including the name, address, and dates of stay.
04
Attach any supporting documentation, such as medical records or invoices, to support your reimbursement claim.
05
Calculate the eligible expenses for reimbursement, including room and board, medical services, and medication costs.
06
Double-check the completed form for accuracy and ensure all required fields are filled out.
07
Sign and date the form before submitting it to the Wisconsin Department of Health Services either through mail or online submission.
08
Keep a copy of the completed form and any supporting documents for your records.
09
Wait for the response from the Wisconsin Department of Health Services regarding the status of your reimbursement claim.
10
Follow any additional instructions or provide any additional information requested by the department to complete the reimbursement process.

Who needs nursing home reimbursementwisconsin department?

01
Individuals who have received nursing home care in Wisconsin and meet the eligibility requirements may need to file for nursing home reimbursement through the Wisconsin Department of Health Services.
02
This may include individuals who self-pay for nursing home care or those who have long-term care insurance policies that cover nursing home expenses.
03
Family members or designated representatives of nursing home residents may also need to file for reimbursement on their behalf.
04
It is important to review the specific eligibility criteria and guidelines set by the Wisconsin Department of Health Services to determine if you or someone you know qualifies for nursing home reimbursement.
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The nursing home reimbursement in Wisconsin is handled by the Wisconsin Department of Health Services.
Nursing homes in Wisconsin are required to file for reimbursement with the Wisconsin Department of Health Services.
To fill out the nursing home reimbursement form, the nursing home must provide detailed information about the care provided and any associated costs.
The purpose of nursing home reimbursement is to ensure that nursing homes are properly compensated for the care they provide to residents.
Nursing homes must report information such as the number of residents, services provided, and associated costs on the reimbursement form.
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