Get Mcm-1 02-07-18 Updated Kepro Address

Filling out the MCM-1 02-07-18 Updated KEPRO Address is a crucial step in obtaining authorization for inpatient or residential services for individuals under the age of 21. This guide provides clear and structured instructions on completing the form accurately and efficiently.

Follow the steps to successfully complete the MCM-1 form online.

1. Press the ‘Get Form’ button to access the MCM-1 document, which will open the form in the online editor.
2. Fill out the Referral Information section. Enter the name of the admitting facility and indicate the type of service requested by selecting either Acute, Residential, or Subacute.
3. Complete the details for the person and agency making the referral, including the name, agency, address, and phone number for both the parent or legal guardian and the agency.
4. In the Member Information section, input the member’s name, date of birth (DOB), and Medicaid number to ensure accurate identification of the individual requiring services.
5. Detail the Presenting Problem by describing the current symptoms, diagnosis, treatment to date, and proposed discharge plan clearly and comprehensively.
6. Complete the Physician’s Certification. Ensure the physician verifies that all specified criteria are met by providing the evaluation date, signature, printed name, and address. Indicate whether a face-to-face evaluation occurred.
7. Review all fields for accuracy and completeness. Save your changes within the online editor.
8. Once all information is complete, download or print the form for submission. Forward the original MCM-1 to the admitting facility and send a copy to KEPRO via fax or mail.

Start completing the MCM-1 form online today to ensure timely access to necessary services.