Get Crihb Options 2016 Client High-level Screening And Eligibility Form - Crihb

Filling out the CRIHB Options 2016 Client High-Level Screening and Eligibility Form online can be a straightforward process. This guide will walk you through each section of the form, ensuring you provide the necessary information for successful completion.

Follow the steps to fill out the form accurately online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In Section 1, enter your client information. Fill in the last name, first name, date of birth in MM/DD/YYYY format, the last four digits of your social security number, any other names used, middle initial, and tribal code or affiliation.
3. Proceed to Section 2, where you verify eligibility for IHS and Medi-Cal coverage. For 2a, indicate if you are IHS eligible by selecting ‘YES’ or ‘NO’. If you select ‘NO’, the client does not qualify, and you should go to Section 4a. If ‘YES’, continue to 2b.
4. In 2b, check if you have Medi-Cal coverage. Select ‘YES’ or ‘NO’. If you choose ‘NO’, the client does not qualify; proceed to Section 4a. If ‘YES’, move to 2c.
5. For 2c, indicate if the client is between the ages of 21-64 by selecting ‘YES’ or ‘NO’. If ‘NO’, the client does not qualify for services; proceed to Section 4a. If ‘YES’, go to Section 4b.
6. Section 3 discusses limitations related to Medicare coverage for clients under 64. Note that they would not be eligible for certain medical services but can qualify for dental services.
7. In Section 4, determine the program eligibility. If the client is not eligible, select ‘Not Eligible for CRIHB Options’. If eligible, choose ‘Eligible for CRIHB Options’ and complete Section 5.
8. For Section 5, you will need to assign an 8-character benefits identification number. Complete the required fields by entering the IHS tribe code, the last four digits of the social security number, the first initial of the last name, and any additional information requested.
9. Sign and print the staff name in the designated area provided, along with the date.
10. Finally, after retrieving and filling the form, ensure you save any changes made. You may download, print, or share the completed form as necessary.

Start filling out your CRIHB Options 2016 Client High-Level Screening And Eligibility Form online today!