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Form: TH09
6/07Virginia
Regulatory
Town Hall. Virginia.nonexempt Action Final Regulation
Agency Background Document
Agency name
Virginia Administrative Code
(VAC) citation
Regulation title
Action
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What is 12 vac 30-120 and?
12 VAC 30-120 is a form used by healthcare providers in Virginia to report certain information related to Medicaid service delivery.
Who is required to file 12 vac 30-120 and?
Healthcare providers who participate in Virginia's Medicaid program are required to file the 12 VAC 30-120 form.
How to fill out 12 vac 30-120 and?
To fill out the 12 VAC 30-120 form, providers must provide detailed information regarding services rendered, patient demographics, and billing details as specified in the instructions accompanying the form.
What is the purpose of 12 vac 30-120 and?
The purpose of the 12 VAC 30-120 form is to ensure accurate reporting and reimbursement for Medicaid services provided by healthcare professionals.
What information must be reported on 12 vac 30-120 and?
Information that must be reported includes patient ID, date of service, type of service rendered, provider details, and any relevant billing codes.
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