Get Medicaid Exceptional Bclaimb Processing Address Bb - Fdhc State Fl

Filling out the Medicaid exceptional claim processing address form can be a straightforward process when approached step by step. This guide is designed to help you navigate the form effectively to ensure your claims are handled properly.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in an editable format.
2. Start by entering the provider name at the top of the form. Ensure that the name matches your registered provider information.
3. Fill in your contact information, including your name and phone number, to facilitate communication about your claim.
4. Input your provider number accurately. This number is essential for identifying your account in the Medicaid system.
5. Indicate that you are requesting an exception to the timely filing limit by checking the appropriate box. Review the criteria to select the one that applies to your situation.
6. For claims older than 12 months, examine Section I and check the relevant reason boxes while attaching any necessary documentation supporting your claim.
7. For claims younger than 12 months, review Section II to identify applicable reasons for the request. Be sure to check the appropriate boxes and attach required documents.
8. If you have another reason for requesting an exception, specify it clearly in Section III.
9. Sign and date the form at the designated area, certifying the authenticity of the information provided.
10. Once completed, mail the form to the designated address, which is Exceptional Claims Processing, P.O. Box 7080, Tallahassee, FL 32314-7080.
11. Finally, consider saving a copy of the form for your records before mailing it.

Complete your documents online to ensure your claims are processed effectively.