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LOUISIANA MEDICAID PROGRAMISSUED: REPLACED: CHAPTER 9: ADULT DAY HEALTH CARE WAIVER APPENDIX E CLAIMS RELATED INFORMATION09/13/21 03/17/21 PAGE(S) 13CLAIMS RELATED INFORMATION Hard copy billing of

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What is may top claim submission?

May top claim submission is the process of submitting a claim for reimbursement or payment for services rendered.

Who is required to file may top claim submission?

Healthcare providers or individuals who have received medical services and are seeking reimbursement or payment.

How to fill out may top claim submission?

May top claim submission can be filled out by providing detailed information about the medical service provided, the cost incurred, and any supporting documents.

What is the purpose of may top claim submission?

The purpose of may top claim submission is to request reimbursement or payment for medical services rendered.

What information must be reported on may top claim submission?

Information such as date of service, type of service provided, cost incurred, and any supporting documentation must be reported on may top claim submission.

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