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Douglas A. Ducey, Governor Jami Snyder, Director November 15, 2019, Mark Wong Division of Medicaid and Children's Health Operations U.S. Department of Health & Human Services Centers for Medicare

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Individuals who are seeking outpatient medical services at an Arizona spa facility will need to fill out the Arizona Spa 19-012 Outpatient form.

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What is arizona spa 19-012 outpatient?

Arizona spa 19-012 outpatient is a form used for reporting outpatient services provided in Arizona.

Who is required to file arizona spa 19-012 outpatient?

Healthcare facilities and providers who offer outpatient services in Arizona are required to file arizona spa 19-012 outpatient.

How to fill out arizona spa 19-012 outpatient?

To fill out arizona spa 19-012 outpatient, healthcare facilities and providers need to report detailed information about the outpatient services provided, such as the type of service, date of service, and patient information.

What is the purpose of arizona spa 19-012 outpatient?

The purpose of arizona spa 19-012 outpatient is to track outpatient services provided in Arizona for billing and regulatory purposes.

What information must be reported on arizona spa 19-012 outpatient?

Information such as the type of service, date of service, patient information, and provider details must be reported on arizona spa 19-012 outpatient.

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