Get the free managed care hospice election/revocation form

MANAGED CARE HOSPICE ELECTION/REVOCATION From This form is used to inform and enable Care Management Organizations (CMOs) to authorize Hospice services provided to eligible Georgia Families members.

How to fill out managed care hospice electionrevocation

How to fill out managed care hospice electionrevocation

1. Obtain the appropriate form for managed care hospice election/revocation.
2. Fill out the form completely and accurately, including your personal information and the date.
3. Check the box indicating whether you are electing or revoking managed care hospice services.
4. Sign and date the form, confirming your decision.
5. Submit the form to the appropriate party as specified on the form, such as your healthcare provider or insurance company.

Who needs managed care hospice electionrevocation?

1. Individuals who are currently enrolled in a managed care hospice program and wish to make changes to their election status.
2. Patients who are considering their options for hospice care and are exploring managed care as a potential choice.

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What is managed care hospice election revocation?

Managed care hospice election revocation is the formal process through which an individual revokes their election to receive hospice care under a managed care plan. This can occur when a beneficiary decides to discontinue hospice services or switch back to standard Medicare coverage.

Who is required to file managed care hospice election revocation?

The beneficiary who wishes to revoke their hospice election or their authorized representative is required to file the managed care hospice election revocation.

How to fill out managed care hospice election revocation?

To fill out a managed care hospice election revocation, the beneficiary or representative must complete the designated form provided by their managed care organization, ensuring all required information is filled out accurately and submitted according to instructions.

What is the purpose of managed care hospice election revocation?

The purpose of managed care hospice election revocation is to allow beneficiaries to officially discontinue their hospice care under a managed care plan, enabling them to revert to other healthcare options or seek different types of treatment.

What information must be reported on managed care hospice election revocation?

The information that must be reported includes the beneficiary's identification details, the effective date of revocation, the name of the hospice provider, and any other required personal and medical information as specified by the managed care plan.