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Ia activity report 2026
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- Click ‘Get Form’ to open the ia activity report in the editor.
- 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.
- 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.
- 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.
- If Medicare coverage applies (Section 4), provide expected coverage dates. This ensures compliance with necessary regulations.
- 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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