Get Distribution: All Providers 03-02 Issued: January ... - State Of Michigan - Michigan

This guide provides clear instructions on how to accurately fill out the Distribution: All Providers 03-02 form, issued by the State of Michigan, focusing on maternity outpatient medical services. Carefully following these steps will ensure that you complete the form correctly and effectively.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the 'Today’s Date' section with the current date.
3. Provide the expected date of confinement or due date. This information is essential for confirming the timeline of services.
4. Enter the beneficiary's name as it appears on their identification documents.
5. Include the beneficiary's date of birth to verify eligibility.
6. Complete the address fields, including street number, apartment number (if applicable), city, state, and ZIP code.
7. If available, input the Medicaid case number and Medicaid beneficiary ID number for accurate processing.
8. Confirm that all required fields are completed, particularly noting that all information is mandatory for processing.
9. If acting as a provider, fill in your contact information, including name, signature, date, and phone number.
10. Review the completed form for accuracy, ensuring all necessary sections are filled before submission.
11. Once verified, save changes, and you can choose to download, print, or share the form as required.

Complete your documents online today to ensure timely and accurate processing of maternity services.