Ia activity report 2026

1. Click ‘Get Form’ to open the ia activity report in the editor.
2. Begin with Section 1: Member Data. Fill in the resident's name, date entered facility, social security number, and state ID. Ensure accuracy as this information is crucial for Medicaid processing.
3. Proceed to Section 2: Facility Data. Enter your provider number/NPI number, facility type, Medicaid case number, and facility name. Complete the address fields including street, city, state, and zip code.
4. In Section 3: Level of Care, indicate the appropriate level based on IME Medical Services Unit or managed care contractor guidelines. Note that this section is not applicable for hospice.
5. If Medicare coverage applies (Section 4), provide expected coverage dates. This ensures compliance with necessary regulations.
6. Finally, complete Section 5: Discharge Data if applicable. Document the reason for discharge and address details where the resident is moving.

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