DMA-5202C-ia 2025

Show details

4.5 out of 5

22 votes

The document outlines the process for designating an authorized representative who can act on behalf of an applicant regarding their application, including signing and accessing information. It includes instructions for changing the representative, responsibilities of both parties, and revocation of the designation. Contact information for assistance is also provided.

Here's how it works

01. Edit your 5202c online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send dhb 5202c via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out DMA-5202C-ia with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the DMA-5202C-ia in the editor.
Begin by entering the 'Name of Applicant/Beneficiary' in the designated field. Ensure that this is the full legal name as it appears on official documents.
Next, fill in the 'Name of Authorized Representative'. This should be the person you are designating to act on your behalf.
Provide the complete 'Address', including Apt/Suite #, City, State, and Zip code. Double-check for accuracy to avoid any delays.
Enter the 'Phone Number' of your authorized representative. This will be crucial for communication regarding your application.
Select your 'Language Preference' from the options provided to ensure effective communication.
Review all information entered for completeness and accuracy before signing. Both you and your authorized representative must sign and date where indicated.

Start filling out your DMA-5202C-ia form online for free today!

See more DMA-5202C-ia versions

We've got more versions of the DMA-5202C-ia form. Select the right DMA-5202C-ia version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (22 Votes)
2013	4 Satisfied (29 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the modifier 25 for Medicaid in NC?

Modifier 25 Used to indicate that on the day a procedure or service was performed, the members condition required a significant, separately identifiable E/M service above and beyond the original service, or above and beyond the usual preoperative and postoperative care associated with the original procedure.

What is the U2 modifier for Medicaid in NC?

When should the U2 modifier be used? If a service was provided through the ER, Urgent Care, or as a referral from these facilities, you need to append the modifier U2 to the claim. This identified that the service was provided there and does not require prior authorization.

What is the U2 modifier used for?

Behavioral Health Billing Modifiers Table ModifierDescription U1 Psychology assistant, psychology assistant intern, psychology assistant trainee // Medicaid level of care 1, as defined by each state U2 Licensed professional counselor // Medicaid level of care 2, as defined by each state /77 more rows

Is medical assistance the same as Medicaid in NC?

Medical Assistance (Medicaid) Social Services determines eligibility for several Medical Assistance Programs (Qu es Medicaid?) based on a variety of guidelines, primarily in the areas of income, financial resources, living arrangements, and in some cases, medical conditions.

What are the new Medicaid rules in NC?

Starting on December 1, 2023, NC Medicaid will cover people ages 19 through 64 years with higher incomes. You may be able to get health care coverage through Medicaid even if you didnt qualify before.

dma 5202c

Dma 5202c ia form Dma 5202c spanish Dma 5202c ia pdf Dma 5202d DMA 5200 Dma 5094 DMA 5201 Dma 5028

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What is NC Medicaid disability?

Individuals with disabilities who are working may receive Medicaid through the Health Coverage for Workers with Disabilities (HCWD) Act (NCGS 108A-66.1). HCWD provides full Medicaid coverage for workers with disabilities ages 16 through 64. An individual must meet the basic Medicaid eligibility requirements.

What is the modifier 59 for Medicaid in NC?

For the NCCI, the primary purpose of CPT modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.

What is NC Medicaid called now?

North Carolinas Transformation to NC Medicaid Managed Care On July 1, 2021, most Medicaid beneficiaries began receiving the same Medicaid services under NC Medicaid Managed Care. With managed care, beneficiaries choose a health plan and get care through the health plans network of doctors.

DMA-5202C-ia 2025

Here's how it works

How to use or fill out DMA-5202C-ia with our platform

See more DMA-5202C-ia versions

Complete this form in 5 minutes or less

Got questions?

What is the modifier 25 for Medicaid in NC?

What is the U2 modifier for Medicaid in NC?

What is the U2 modifier used for?

Is medical assistance the same as Medicaid in NC?

What are the new Medicaid rules in NC?

Complete this form in 5 minutes or less

People also ask

What is NC Medicaid disability?

What is the modifier 59 for Medicaid in NC?

What is NC Medicaid called now?

dhb 5202

Try more PDF tools