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- Click ‘Get Form’ to open the 1 CENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL - med-quest in the editor.
- Begin by reviewing the Scope of Services section. Ensure you understand the nursing facility services required and confirm compliance with relevant regulations.
- Fill in the Reimbursement section accurately. Note that you must submit a statement of services for each Medicaid eligible resident within thirty days following discharge.
- Complete the Reports section by entering all necessary data regarding admissions, discharges, and absences. Make sure to adhere to submission deadlines.
- Finally, sign and date the form at the bottom. Ensure that your name is printed clearly as the Provider/Authorized Business Agent.
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