Get Ok 02cb009e (adv9) 2010-2025

The OK 02CB009E (ADv9) form is an essential document for notifying changes in a member's status within the Advantage Program. This guide will walk you through the steps to complete the form online effectively.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to access the OK 02CB009E (ADv9) form and open it in your preferred form editor.
2. Begin by entering the member's full name in the designated fields. Include the last name, first name, and middle initial.
3. Next, provide the Medicaid number for the member, ensuring the information is accurate to avoid any potential issues.
4. Indicate the county where the member resides in the appropriate field.
5. In the 'Response requested' section, specify whether a status change is applicable by checking the relevant option.
6. If there is a status change, fill out the effective dates for suspending or resuming services as required.
7. Provide details regarding hospitalization, vacation, or nursing facility placement, selecting the options that apply.
8. Complete the 'Reason for status change' section, explaining the justification for the changes you are reporting.
9. If applicable, provide an explanation of hospitalizations or temporary nursing facility placements in the specified area.
10. In the 'Comments/other' section, include any additional information that may be important for processing.
11. Lastly, ensure that 'Submitted by' is filled out with the name of the individual completing the form and the agency name, along with the date of submission.
12. Once all sections are complete, you can choose to save the changes, download the form, print it, or share it as needed.

Complete your OK 02CB009E (ADv9) form online for a smooth experience.