Get Medicare Provider Number 14-0117 Medicaid Provider Number 3066 State Illinois From 07-01-2006 To
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How to fill out the Medicare Provider Number 14-0117 Medicaid Provider Number 3066 State Illinois From 07-01-2006 To online
This guide provides a comprehensive overview for users looking to fill out the Medicare Provider Number 14-0117 and Medicaid Provider Number 3066 forms. It breaks down each section and offers clear instructions for completing the documentation online.
Follow the steps to successfully complete your Medicare and Medicaid provider forms.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the general information section. Enter the name of the hospital, which in this case is Resurrection Medical Center, and the street address, 7435 West Talcott. Make sure to also include the city, Chicago, and the state, Illinois, along with the zip code 60631.
- In the period covered by the statement, indicate the start date as 07-01-2006 and the end date as 06-30-2007. This is crucial for accurate reporting and compliance.
- Next, input the Medicare Provider Number (14-0117) and Medicaid Provider Number (3066) in their respective fields. Ensure these numbers are correct as they are vital for processing claims.
- Select the type of control for the hospital. You will choose from options such as voluntary nonprofit, government, individual, etc., based on the hospital’s operational structure.
- For the type of hospital, select the appropriate category such as general short-term, psychiatric, rehabilitation, or any other that matches the hospital's specialization.
- Complete the inpatient and outpatient statistics sections by entering the required data regarding total available beds, bed days, and patients treated during the reporting period.
- Finally, review all the entered information for accuracy. After confirming all details are correct, save your changes, download the form, print or share as needed to submit your provider numbers.
Complete your Medicare and Medicaid documentation online today to ensure compliance and accurate reporting.
Obtaining Medicaid in Illinois can vary in difficulty based on your individual circumstances. While the application process may seem daunting, knowing what documents you need and having your Medicare Provider Number 14-0117 and Medicaid Provider Number 3066 can make it much more manageable. Using resources like US Legal Forms can offer guidance to simplify the process and help you get the support you need.
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