Get Ma Blue Cross Recertification Form For Snf/rehab/ltch 2019-2025

This guide provides detailed instructions on completing the MA Blue Cross Recertification Form for skilled nursing facilities, rehabilitation hospitals, or long-term care hospitals online. Follow these steps to ensure an accurate and efficient submission process.

Follow the steps to complete the form efficiently.

1. Press the ‘Get Form’ button to access the MA Blue Cross Recertification Form and open it for editing.
2. Begin with Section A, where you will enter member and facility information. Fill in the member's name, date of birth, Blue Cross Blue Shield member ID number, and the date of evaluation. Also, ensure you provide the facility name.
3. Proceed to Section B. Here, input the facility’s National Provider Identifier (NPI) number, specify the requested number of days, and provide the contact person's name and phone number. Additionally, fill in the admit and discharge dates.
4. In Section C, describe the clinical status and treatment details. Indicate the patient's alertness, ability to follow commands, and pain levels along with vital signs and required treatments, such as oxygen needs or dressing changes.
5. Continue to Section D, where you will assess and record the current level of function for activities of daily living (ADLs). Specify the assistance required, walking distance, endurance, and any devices the patient uses.
6. In Section E, outline the discharge plan and goals, including any social barriers or concerns that may impact the patient's transition.
7. Finally, complete Section F, indicating the anticipated discharge date, destination, needs upon discharge, and whether a Medicaid application has been initiated. Choose the relevant options accordingly.
8. Once all sections are completed, review the form for accuracy and make any necessary changes. After verification, save your changes, and choose to download, print, or share the completed form as required.

Start completing the MA Blue Cross Recertification Form online today to streamline your recertification process.