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Member Services Mail Route CP540 PO Box 9310 Minneapolis, MN 554409310APPEAL Formica MinnesotaCare Media Choice Care PMAPMedica ID Number: Member Name: Telephone Number: Dear Member: This form is
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fact-sheet-medica-choice-care-pmap-minnesota is a form used to report information about the Medica Choice Care PMAP program in Minnesota.
Healthcare providers participating in the Medica Choice Care PMAP program in Minnesota are required to file the fact-sheet.
The fact-sheet can be filled out by providing the required information, such as patient details, services provided, and payment received, in the designated fields.
The purpose of the fact-sheet is to ensure accurate reporting of services provided under the Medica Choice Care PMAP program.
Information such as patient demographics, services provided, and payments received must be reported on the fact-sheet.
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