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FOR BHF USELL1
2015
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2015)I.DPH License ID Number:
Facility
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Presence Maryhaven NSG AMP stands for Presence Maryhaven Nursing and Rehabilitation Center Annual Medicaid Provider report.
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All Medicaid providers who provide services to residents of Maryhaven Nursing and Rehabilitation Center are required to file the Presence Maryhaven NSG AMP report.
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The purpose of the Presence Maryhaven NSG AMP report is to ensure that Medicaid providers are accurately reporting the services provided to residents of Maryhaven Nursing and Rehabilitation Center for Medicaid reimbursement.
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The Presence Maryhaven NSG AMP report must include information on the services provided, the Medicaid rate of reimbursement, and the number of residents served at Maryhaven Nursing and Rehabilitation Center.
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