Get Leacost Form

Completing the Leacost Form online is a crucial step for governmental providers to certify their public expenditures. This guide provides step-by-step instructions to assist users in accurately filling out the form to ensure compliance with regulations.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name and address of the governmental provider in the designated fields at the top of the form.
3. Next, specify the reporting period by entering the Medicaid State Plan Rate Year. Indicate the starting and ending dates in the 'From' and 'To' fields, respectively.
4. Fill in the Medicaid Provider Number (NPI) in the provided space to identify the service provider.
5. Select the type of report being submitted by checking the appropriate box, which may include options such as 'Partial Period Report,' 'Quarterly Cost Report,' 'Full Year Cost Report,' or 'Revised Cost Report.'
6. Input the total computable certified public expenditure by component in the relevant section, ensuring all figures are accurate.
7. Carefully review the certification statement, then sign and date it, ensuring the officer authorized to submit the form is the one signing.
8. Finally, save the changes to the form. You may also choose to download, print, or share the completed form as needed.

Complete your documents online today and ensure compliance with your reporting requirements.