Get Dhs 4461

The Dhs 4461 form, also known as the Nursing Facility Communication Form, is essential for effective communication between nursing facilities, health plans, and the Department of Human Services. This guide provides clear instructions on how to accurately complete the form online, ensuring that all necessary information is included for proper processing.

Follow the steps to complete the Dhs 4461 effectively.

1. Click ‘Get Form’ button to access the Dhs 4461 form and open it in your preferred editing tool.
2. In the 'Member Information' section, fill in the member's name, date of birth, health plan ID, and PMI. Additionally, document where the member was admitted from and where they will be discharged to.
3. Enter the admit diagnosis code (ICD-10) and any relevant notes regarding the member's condition.
4. Proceed to the 'Facility Information' section. Input the nursing facility's name, provider NPI, street address, phone number, city, state, zip code, and contact details (name, fax number, and email address).
5. Fill out the 'Member Tracking Information' section. Include the date of reason code, reason code, number of bed hold days, RUG rates or dollar amount, and indicate if the member qualifies for Medicare stay by selecting 'Yes' or 'No' as appropriate.
6. Document the days that Medicare will be liable for since initial admission, total days since initial admission, and the remaining number of days liable to the health plan.
7. Provide the date the form was faxed to the health plan and ensure that all reason codes are included regarding the member's status and care.
8. Complete the 'For Health Plan Use' section by leaving blank fields for Health Plan personnel to fill out. Ensure the form is double-checked for accuracy.
9. Finalize the process by saving your changes, downloading a copy, printing it for records, or sharing it with the necessary parties.

Complete the Dhs 4461 form online today to ensure efficient processing of nursing facility communications.