Get Pa Ma 552 2015-2025

The PA MA 552 form is an important document for Medicaid recipients, specifically used to notify managed care organizations about a member's pregnancy. Prompt and accurate completion of this form ensures that members receive timely access to necessary maternity programs and services.

Follow the steps to successfully complete the PA MA 552 form online.

1. Use the 'Get Form' button to acquire the PA MA 552 form and open it in an appropriate editor.
2. Begin by filling out the OB/GYN Office Information section. Provide the practice name, phone and fax numbers, provider MAID number, as well as the relevant fax dates for the first prenatal visit, 28-32 week visit, and postpartum visit. Ensure that the form is completed by a qualified healthcare professional.
3. Next, fill out the Member’s Information section. This includes capturing the first and last names of the member, their date of birth, age, member ID or MAID number, health plan details, contact numbers, primary and secondary languages, as well as their choice of hospital for delivery.
4. Document key information about the member’s pregnancies, such as the date of the first prenatal visit, expected date of confinement, gestational age at the first visit, and historical pregnancy data including full-term and pre-term pregnancies.
5. Complete the middle section regarding past obstetric complications, current risks, and active medical or mental health conditions. If none are applicable, make sure to check the corresponding boxes to indicate this.
6. Fill in details regarding delivery and postpartum information including birth weight, prenatal visit dates, and screening for postpartum depression.
7. Review the entire form for any missing information, ensuring all sections have been filled out completely and accurately. Attach any additional information if necessary.
8. Once all information is accurately entered, users can save their changes, download the form, print it, or share it as needed.

Start filling out the PA MA 552 online now to ensure expedited enrollment in necessary maternity programs.