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Get 180 Day Exception Request Detail Page
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How to fill out the 180 Day Exception Request Detail Page online
Completing the 180 Day Exception Request Detail Page correctly is crucial for ensuring your request is processed efficiently. This guide provides a step-by-step approach to help you navigate the form with ease.
Follow the steps to successfully complete the 180 Day Exception Request Detail Page
- Click ‘Get Form’ button to access the form and open it in your preferred online editor.
- Begin with Item 1: Enter the provider's name as it appears on official documentation.
- Proceed to Item 2: Enter the MA ID Number assigned to the provider, ensuring accuracy to avoid delays.
- In Item 3, enter the recipient's name clearly, as this will be referenced throughout the process.
- For Item 4, depending on the service type, enter the discharge date for inpatient services or the date of service for outpatient services.
- Item 5 requires you to specify the date the application was mailed to the CAO if the exception is due to a CAO delay. Remember to provide documentation supporting this date.
- Item 6 asks for the process date of the PA 162 form, if relevant. A copy of the PA 162 must accompany your request.
- Proceed to Item 7: If applicable, indicate the date the payment request was mailed to the third party. Documentation is required.
- In Item 8, enter the process date of the third-party statement, attaching a copy as required.
- For Item 9, if relevant, list the date the MA 424 was processed by the Department, and include a copy as documentation.
- Item 10 pertains to the 'Date of Notice' from the notification letter, which must also be included in your submission.
- In Item 11, enter the date the MA invoice was mailed to the Department of Public Welfare, ensuring this is accurate.
- In Item 12, mark (√) the appropriate block to indicate why an exception is being requested.
- Finally, in Item 13, have the responsible person sign and date the form. Also, provide their telephone number, as stated in Item 14.
Complete your 180 Day Exception Request Detail Page online today.
2. What is the time limit for submitting claims to Medical Assistance? The original claim must be received by the department within a maximum of 180 days after the date the services were rendered or compensable items provided.
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