Get Cbes Category Of Service Line Definitions For The 64 9 Base Form

This guide provides clear instructions on how to complete the Cbes Category of Service Line Definitions for the 64 9 base form online. It is designed to assist users with varying levels of experience in digital document management.

Follow the steps to accurately complete your form.

1. Click the ‘Get Form’ button to access the form and open it in your online editing tool.
2. Begin by identifying the necessary fields in the form. Each line corresponds to a specific category of service that needs to be defined clearly as per the guidelines provided in the State Medicaid Manual.
3. For Line 1.A, report the gross premiums paid for children whose family income is up to 150% of the Federal poverty level. Ensure that you are including the total premiums without netting any offsets.
4. On Line 1.B, report any cost-sharing offsets related to the total reported on Line 1.A. Make sure these figures are distinct from those on Line 1.A.
5. Line 1.C requires reporting gross premiums paid for children above 150% of the Federal poverty level. Follow the same guidance: do not net offsets with premiums.
6. For Line 1.D, document cost-sharing offsets associated with the amounts reported in Line 1.C, ensuring that this is reported separately.
7. Continue through the form by following the definitions provided for each line, ensuring detailed and accurate reporting for services such as inpatient hospital, mental health, nursing care, and other practitioner services.
8. Once all relevant sections are completed, review the entire form for accuracy before finalizing.
9. At the final stage, save your changes, and choose to download, print, or share the completed form according to your needs.

Complete your forms quickly and accurately by following this guide, and ensure seamless documentation online.