Get Ny Ldss-3559 2013-2026

The NY LDSS-3559 is a crucial document used for reporting Medicaid recipient admissions, discharges, readmissions, or changes in status in residential health care facilities. This guide will assist you in filling out the form online accurately and efficiently, ensuring compliance with Medicaid requirements.

Follow the steps to fill out the NY LDSS-3559 online

1. Press the ‘Get Form’ button to access the NY LDSS-3559 and open it in the online editor.
2. Begin entering the reporting facility's name at the top of the form where indicated.
3. Provide the patient’s or resident’s local Department of Social Services office in the designated section.
4. Fill in the patient’s or resident’s full name (Last, First, M.I.) in the appropriate fields.
5. Enter the provider number associated with the facility where the patient is admitted.
6. Select the type of placement by marking one of the options: SNF (Skilled Nursing Facility) or ICF (Intermediate Care Facility).
7. Enter the Medicaid client identification number for the recipient.
8. Input the date of admission or readmission in the specified field.
9. Provide the social security number of the patient or resident.
10. Fill in the date of discharge or transfer, if applicable.
11. Complete the section indicating the facility or home address from which the patient is being discharged.
12. Specify the facility or home address to which the patient is being transferred, or indicate if deceased.
13. Indicate whether a bed was reserved by selecting ‘Yes,’ ‘No,’ or ‘Not applicable.’
14. Confirm if the patient is enrolled in Medicaid Managed Care by selecting ‘Yes’ or ‘No.’
15. Indicate if the Medicaid Managed Care plan was notified of the admission, discharge, or change in status, and enter the date notified.
16. Provide the name of the Medicaid Managed Care plan, if applicable.
17. Choose the placement situation for the patient by selecting one option that describes their expected length of stay.
18. Complete the health insurance information section, indicating if the individual has Medicare or other health insurance.
19. Print the name of the individual completing the form and add their title, date, and contact telephone number.
20. Review the completed form for accuracy before the final submission.
21. Save changes to the document, and choose to download, print, or share the form as needed.

Start filling out your forms online today to ensure timely processing.