4,647 Results for
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Posting Date: 05/16/2012
Interim Rate Review Documentation Request Form for Critical Access Hospitals
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Posting Date: 04/12/2021
Website Feedback Form
Website Feedback Form We value your feedback about our website. Please tell us about your experience and provide any suggestions for improvement. This form is for the submission of feedback regarding your recent website experience; it [...]
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Posting Date: 01/26/2021
RM 3_HHH_Who May File an Appeal
What if the Appointment of Representative Form Is Incomplete or Defective? If the Represented Party is the Provider The MAC notifies both the person submitting the appointment and the provider that the appointment is incomplete or defective. [...]
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Posting Date: 01/27/2021
RM 2_A-HHH-FQHC_Who May File an Appeal
Required Elements The following information must be included on an Appointment of Representative (CMS-1696) form or written statement: Name, address, phone number of party (i.e., the beneficiary, facility, physician, or other supplier) NPI [...]
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