Get Status Change For Members In A Nursing Facility Or

This guide provides an easy-to-follow approach for completing the Status Change For Members In A Nursing Facility Or form online. By following the steps outlined below, users can efficiently manage status changes for individuals in nursing facilities.

Follow the steps to fill out the Status Change form correctly.

1. Click 'Get Form' button to obtain the form and access it in your preferred editor.
2. In Section 1, complete items 1 through 12 which include provider details and member information. Ensure to enter the provider ID, provider name, and the member's last name, first name, and other identifying information.
3. In Section 2, state the type of status change by selecting the appropriate option (Admit, Discharge, or Both). Based on your selection, fill in the necessary details regarding the type of bed, admission and discharge dates, and reasons for discharge.
4. In Section 3, enter the MassHealth requested payment date and explain the reason for the payment request. Additionally, provide details about the length of stay for nursing facility services and the clinical eligibility for these services.
5. If applicable, complete the certification of short-term stay in Item 23 and have the physician sign in Item 24. Also, specify the Medicare end date if relevant.
6. Ensure that all required items, including those in items 26 to 33, are completed accurately. Confirm whether attachments like the nursing facility clinical eligibility determination form or OBRA/PASARR form are included.
7. Finally, sign the form in items 34 and 35, providing the date of completion, and review all entries for accuracy.
8. Once complete, you can save changes, download, print, or share the form as needed.

Complete your documents online today for efficient management of nursing facility member status changes.