Get Ca Calpers Continued Monthly Residence Form 2018-2025

Completing the CA CalPERS Continued Monthly Residence Form accurately is essential for ensuring timely reimbursement for long-term care services. This guide provides you with a clear, step-by-step approach to filling out the form online effectively.

Follow the steps to complete the form online easily.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the facility name, address, city/state, phone number, and fax number in the designated fields. Ensure all information is accurate and up to date.
3. Next, fill in the resident's name, policy number, room number, move-in date, and the month of service. It is crucial to provide complete and correct information for all fields.
4. Indicate whether the resident has remained in the same room throughout the month by selecting 'Yes' or 'No'. If 'No', provide the prior room or apartment number in the space provided.
5. Select the level of care that best describes the resident’s living situation. Choose from the provided options, including assisted living and skilled nursing.
6. Answer the question regarding overnight absences. If the resident was away, note the departure and return dates, and provide the reason for the absence. For hospital stays, include the admission and discharge dates.
7. Indicate whether Medicare, Medicaid/MediCal, or any other insurance is covering expenses during the service period. If applicable, provide the necessary documentation and contact details of associated case workers or insurers.
8. Finally, verify the information provided is correct by signing and dating the form. Clearly print your name, title, and phone number in the designated sections.
9. Once completed, save the changes, download the form, and prepare it for submission. You can print or share the form as needed.

Complete the CA CalPERS Continued Monthly Residence Form online today to ensure efficient processing of your claims.