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Medicare Part D Prescription Drug Claim Section 1 Cardholder Information Cardholder #Group #Cardholder Name (Last, First)Date of BirthStreet Address CityPhone # StateZipSection 2 Other Prescription

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What is h9712mi-mmp-m-2413434 mmp esi direct?

h9712mi-mmp-m-2413434 mmp esi direct is a specific form used for reporting information related to the Medicare-Medicaid Plan (MMP) under the Coordinated Care initiative, particularly involving enrollment, eligibility, and service information.

Who is required to file h9712mi-mmp-m-2413434 mmp esi direct?

Entities that manage Medicare-Medicaid Plans (MMPs) are required to file the h9712mi-mmp-m-2413434 mmp esi direct form. This typically includes health plans operating in dual eligible environments.

How to fill out h9712mi-mmp-m-2413434 mmp esi direct?

To fill out the h9712mi-mmp-m-2413434 mmp esi direct, the filing entity must provide accurate and complete information regarding member eligibility, services rendered, and any other required data specified in the form's instructions.

What is the purpose of h9712mi-mmp-m-2413434 mmp esi direct?

The purpose of h9712mi-mmp-m-2413434 mmp esi direct is to ensure proper tracking and reporting of services provided to members enrolled in Medicare-Medicaid Plans, facilitating compliance with federal regulations and improving care coordination.

What information must be reported on h9712mi-mmp-m-2413434 mmp esi direct?

The form requires reporting information such as member demographics, eligibility status, service details, and any claims-related information pertinent to the MMP services provided.

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