Get Pa Ma 552 2018-2025

The PA MA 552 form is essential for Medicaid recipients participating in a HealthChoices Managed Care Organization or the Fee for Service delivery system and serves as an important notification of a member's pregnancy. This guide provides user-friendly, step-by-step instructions on completing the form accurately and efficiently.

Follow the steps to complete the PA MA 552 online with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Complete the OB/GYN Office Information section. Enter your practice name, phone number, fax number, the provider’s MAID number, and the date the form will be initially faxed.
3. Fill out the Member’s Information section. Provide the member's full name, date of birth, age, member ID, and health plan details. Ensure to document the first prenatal visit date and the expected date of confinement.
4. In the Past OB Complications section, indicate if the member has any complications from previous pregnancies. If none, mark the appropriate box.
5. Moving to the Current Risks section, identify any potential risks that could affect the member's current pregnancy.
6. Document any Active Medical/Mental Health Conditions in the relevant section. Ensure that you specify conditions such as autoimmune disorders or mental health concerns.
7. In the Social, Economic, Lifestyle section, note any issues that may affect the pregnancy, marking 'No' if none apply.
8. Document details related to delivery, including the date, gestational age, and if the baby was admitted to NICU.
9. Fill in the Postpartum Visit section with relevant dates and screening information.
10. Review all sections for completeness, ensuring no question is left blank. Save changes as needed and download or print the completed form for submission.

Complete your PA MA 552 form online today to ensure timely processing and care.