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Page 1 of 72023 Enrollment Request Form o UnitedHealthcare Dual Complete Choice (PPO DSP) H0271013000 UO7Information about you (Please type or print in black or blue ink) Last NameFirst Rebirth Date
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How to fill out dual eligible special needs
How to fill out dual eligible special needs
01
Determine eligibility for dual eligible special needs by meeting both Medicare and Medicaid requirements.
02
Enroll in a dual eligible special needs plan offered by a Medicare-approved organization.
03
Choose healthcare providers within the plan's network.
04
Utilize benefits and services provided by both Medicare and Medicaid.
Who needs dual eligible special needs?
01
Individuals who are eligible for both Medicare and Medicaid benefits.
02
Those who require additional support for their healthcare needs beyond what Medicare or Medicaid alone can provide.
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What is dual eligible special needs?
Dual eligible special needs refers to individuals who are eligible for both Medicare and Medicaid benefits.
Who is required to file dual eligible special needs?
Health care providers who provide services to dual eligible individuals are required to file dual eligible special needs.
How to fill out dual eligible special needs?
Dual eligible special needs forms can be filled out electronically or manually, following the specific guidelines provided by the governing agency.
What is the purpose of dual eligible special needs?
The purpose of dual eligible special needs is to ensure coordination of care for individuals who are eligible for both Medicare and Medicaid benefits.
What information must be reported on dual eligible special needs?
Information such as the services provided, dates of service, and patient demographics must be reported on dual eligible special needs forms.
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