Get Form Aas 9559

This guide provides a professional and clear approach to filling out the Form Aas 9559 online for attendant care providers. It aims to assist users in accurately completing the form to ensure timely processing and payment.

Follow the steps to successfully complete the Form Aas 9559.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the top section with the Alternatives participant's information as completed by the counselor or DHS RN.
3. In the middle section titled 'Attendant Care Billing', enter each day's work details: date, day of the week, time in, time out, hours worked, units worked (hours multiplied by 4), and the billing amount (units multiplied by $2.43). Use one line for each workday.
4. Total the hours, units, and billing amount at the end of the billing section and transfer these totals to the appropriate 'TOTALS' boxes.
5. In the 'Provider Information' section at the bottom, print your name, Medicaid Provider Identification Number (PIN), Social Security number, address, and telephone number.
6. Sign and date the claim form. Ensure the Alternatives participant or an authorized person also signs and dates the form.
7. Once completed, do not fax the form. Mail the original claim forms to EDS Federal Corporation, DAAS Claims, P.O. Box 709, Little Rock, AR 72203.

Submit your billing claims accurately online to ensure prompt payment.