Get 2159i 2020-2025
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How to fill out the 2159i online
The 2159i form is essential for certifying the permanent placement status of a consumer in a Medicaid-managed care facility. This guide provides clear, step-by-step instructions to help users through the online completion of this form, ensuring that all necessary information is accurately provided.
Follow the steps to complete the 2159i online effectively.
- Click ‘Get Form’ button to obtain the form and open it for online completion.
- Begin by entering the name of the facility where the consumer is placed in the designated section.
- Input the address of the facility in the appropriate field, ensuring accuracy to prevent processing delays.
- Select the name of the Medicaid managed care plan to which the consumer is affiliated.
- Provide the plan provider ID in the specified area, which should be readily available from the care plan documentation.
- Next, fill in the name of the consumer and their CIN (Client Identification Number) to properly identify them.
- Indicate the effective date for the consumer's permanent placement status using the date fields provided.
- Select the placement/bed type from the options listed, ensuring you have authorization attached as specified on the form.
- Both the managed care plan and the residential healthcare facility must provide their signatures along with the submitter's details, including contact information.
- Once all sections have been filled, review the form for accuracy and completeness before saving your changes.
- Finally, download, print, or share the completed form as required for submission.
Start filling out your 2159i form online today to ensure smooth processing of permanent placement certifications.
In North Carolina, qualifying for Medicaid with a disability may not be automatic. The state evaluates individual circumstances, including financial and medical criteria. Therefore, it’s essential to understand how the 2159i form fits into the application process. Completing this form can help clarify your eligibility and streamline your application.
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