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DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE MEDICAID SERVICESFORM CMS416: ANNUAL EPS DT PARTICIPATION REPORT
State Code
NM
1a. Total individuals
eligible for EPS DT
1b. Total Individuals
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How to fill out form cms-416 annual epsdt
How to fill out form cms-416 annual epsdt
01
Gather all necessary information such as demographics, medical records, and billing information.
02
Review the instructions provided on the form CMS-416 to understand the requirements and guidelines for completion.
03
Fill out each section of the form accurately and completely, providing all requested information.
04
Double-check the form for any errors or missing information before submitting.
05
Submit the completed form CMS-416 by the specified deadline.
Who needs form cms-416 annual epsdt?
01
Healthcare providers participating in the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
02
Medical professionals responsible for providing preventive and comprehensive health services to Medicaid-eligible individuals under the age of 21.
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What is form cms-416 annual epsdt?
Form CMS-416 annual EPSDT is a report used by states to provide information on Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program services provided to Medicaid-eligible individuals under the age of 21.
Who is required to file form cms-416 annual epsdt?
States that participate in the Medicaid program are required to file Form CMS-416 annual EPSDT.
How to fill out form cms-416 annual epsdt?
Form CMS-416 annual EPSDT is filled out by states based on the data collected from EPSDT screenings and treatments provided to Medicaid-eligible individuals under 21.
What is the purpose of form cms-416 annual epsdt?
The purpose of Form CMS-416 annual EPSDT is to monitor and evaluate the effectiveness of the EPSDT program in providing preventive and comprehensive healthcare services to Medicaid-eligible children.
What information must be reported on form cms-416 annual epsdt?
Information such as the number of individuals screened, diagnostic services provided, treatment services provided, and the costs associated with EPSDT services must be reported on Form CMS-416 annual EPSDT.
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