Get Hcpf Om 19-057 Form Ap-5615, County Submissions To Financial Compliance Unit For Review

Filling out the HCPF OM 19-057 Form AP-5615 is an essential process for eligibility sites to report resident information accurately. This guide will provide clear and detailed steps to help you complete the form online effectively.

Follow the steps to complete your form accurately.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the required resident information in the designated fields. Ensure that all information is accurate and up-to-date.
3. Provide the details of the Nursing Facility (NF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) that the resident is associated with, including relevant contact information.
4. Calculate the patient's liability amount based on the latest income and status data, ensuring that it aligns with regulatory requirements.
5. Include the effective date for the new patient liability amount at the specified location on the form.
6. Ensure that the eligibility worker responsible for the submission signs the form, confirming the accuracy of the information provided.
7. Finalize the form by checking that it is complete and readable before preparing it for submission.
8. Save the completed form as a PDF document, as this is the required format for submission.
9. Email the completed Form AP-5615 to HCPF_LTC_FinCompliance@state.co.us, using the NF or ICF-IID name followed by '5615' as the subject line.
10. Upon submission, ensure to maintain a copy for your records for future reference.

Start filling out the HCPF OM 19-057 Form AP-5615 online today to ensure compliance and timely submission.