Get Va Dmas-80 2019-2025

Filling out the VA DMAS-80 is crucial for communicating nursing facility admissions, discharges, or level of care changes for individuals who are members of the Commonwealth Coordinated Care Plus program. This guide will provide a clear, step-by-step process to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the VA DMAS-80.

1. Click the ‘Get Form’ button to access the VA DMAS-80 form and open it in your preferred editor.
2. Enter the date the form is being completed in the designated space.
3. Select the reason for submission by checking the appropriate box for admission, discharge, or level of care change.
4. Provide the individual's full name in the specified fields including first name, middle initial, and last name.
5. Fill in the individual's complete date of birth in the correct format.
6. Select the appropriate gender by marking the relevant box.
7. Enter the complete 12-digit Medicaid number required for processing the form.
8. Provide the individual’s social security number by entering it into the designated field.
9. Input the nursing facility's name, complete address, and 10 to 12 digit National Provider Identifier (NPI) number.
10. Record the admission date and, if applicable, the discharge date for the individual.
11. Fill in the health plan name and fax number for the respective managed care health plan.
12. Answer the questions related to the individual's admission and level of care change appropriately.
13. Check the boxes for admission type, specifying whether it is custodial care or Medicare/Commercial skilled care.
14. Mark the appropriate current payment source by checking the relevant box.
15. If necessary, provide any additional comments in the optional comments section.
16. Have the individual completing this form print their name, sign it, and enter the date.
17. After completing the form, ensure to save changes and then download, print, or share the finished VA DMAS-80 as needed.

Complete and submit your VA DMAS-80 form online today for efficient processing!