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OPERATIONAL MEMO
TITLE:COST CONTAINMENT FORM REQUIREMENTS AND CSR
REQUIREMENTS FOR THE CHUBS WAIVER CHANGESSUPERSEDES NUMBER:N/EFFECTIVE DATE:MAY 1, 2022DIVISION AND OFFICE:CASE MANAGEMENT AND QUALITY
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Indicate the purpose of the form and the specific cost you are requesting for.
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The HCPF OM 22-017 cost is needed by individuals or organizations who require reimbursement or coverage for specific costs related to healthcare, medical services, or related expenses. This form is typically used by individuals who are eligible for Medicaid programs or anyone seeking financial aid for healthcare costs. It is also utilized by healthcare providers and service providers who need to request reimbursement for services provided to Medicaid beneficiaries.
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hcpf om 22-017 cost refers to the cost associated with a specific healthcare program. The cost can vary depending on the services provided.
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