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OMB No: 09381378 Expires: 7/31/2024Individual Enrollment Request Form to Enroll in a Mutual Advantage Plan Central Ohio, Cincinnati/Dayton and Toledo Brown, Butler, Clark, Clermont, Delaware, Fairfield,

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Individuals who are applying for or receiving benefits from the Social Security Administration may need to fill out OMB No 0938-1378.

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What is omb no 0938-1378?

OMB No 0938-1378 is a form used by the Centers for Medicare & Medicaid Services (CMS) to collect information from healthcare providers.

Who is required to file omb no 0938-1378?

Healthcare providers who participate in Medicare or Medicaid programs are required to file OMB No 0938-1378.

How to fill out omb no 0938-1378?

OMB No 0938-1378 can be filled out electronically through the CMS website or by submitting a paper form with the required information.

What is the purpose of omb no 0938-1378?

The purpose of OMB No 0938-1378 is to collect data on healthcare services provided to Medicare and Medicaid beneficiaries for monitoring and quality improvement purposes.

What information must be reported on omb no 0938-1378?

Information to be reported on OMB No 0938-1378 includes details on services provided, patient demographics, and billing information.

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