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Get Wisconsin Form F 01020 Fillable
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How to fill out the Wisconsin Form F 01020 Fillable online
Filling out the Wisconsin Form F 01020 Fillable is essential for requesting a nursing home care determination. This guide provides clear steps to assist you in completing the form accurately and efficiently.
Follow the steps to fill out the Wisconsin Form F 01020 Fillable online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with Section I — Provider Information. Fill in the billing provider's name, national provider identifier, and taxonomy code. Ensure the ZIP+4 code is accurate, and include the billing provider's Medicaid provider number along with the complete address.
- Continue filling in Section I by providing the name and telephone number of the nursing home contact person. Double-check all entries for accuracy.
- Move to Section II — Member Information. Select whether this is a new or initial request or a revised start date. Enter the member’s full name, social security number, and identification number. Make sure to include their date of birth, and indicate their gender.
- Specify the requested start date for nursing home authorization and the nursing home discharge date, if applicable. Review all entries for correctness.
- For cases where an MDS Admission Assessment will not be submitted to CMS, provide the necessary attachments, including physician's orders, nursing medical notes, and discharge summary.
- Once all fields are completed, save your changes. You may download, print, or share the completed form as needed.
Complete your documents online for a streamlined process.
In Wisconsin, the time it takes to get approved for Medicaid can vary significantly, usually ranging from a few weeks to a couple of months. Utilizing the Wisconsin Form F 01020 Fillable can help streamline your application by ensuring all necessary information is included. It’s important to keep track of submission dates and follow up on your application. Staying proactive can help mitigate delays.
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