Get Va Cost Sharing Medical Expense Record 2016-2025

Filling out the VA Cost Sharing Medical Expense Record is an essential step for users seeking reimbursement for eligible medical expenses. This guide provides clear instructions to help you navigate the online form with ease and accuracy.

Follow the steps to complete the form successfully.

1. Click 'Get Form' button to obtain the Cost Sharing Medical Expense Record and open it in the editor.
2. Fill in your personal details in the designated sections, such as your name and phone contact number.
3. Enter your HIPP for Kids case number and the expense period relevant to your reimbursement request.
4. In the cost sharing medical expense record section, list the names of the Medicaid child under age 19 and the parent who received the service.
5. Indicate the relationship to the employee in the provided field.
6. List the name of the services provider, specifying the type of service received.
7. Record the service date, ensuring to provide the correct dates, from when the service was provided to when it concluded.
8. Finally, input the total amount you paid for each listed service.
9. Sign and date the form to certify the accuracy of the provided information and process for reimbursement.
10. After completing the form, ensure to save changes, download, print, or share the document as needed.

Begin completing your documents online today to facilitate your reimbursement process.