Dmas 98r 2026

1. Click ‘Get Form’ to open the dmas 98r in the editor.
2. Begin by selecting the request type: New, Change, Cancel, or Transfer. Place a checkmark in the appropriate box.
3. Enter the Date of Request in MM/DD/YYYY format.
4. Fill in the Member Medicaid ID Number, ensuring it is a valid 12-digit number.
5. Complete the Member's Last Name and First Name as they appear on their Medicaid card.
6. Input the Date of Birth using MM/DD/YYYY format and select the Member's Gender by marking Male or Female.
7. Provide the Primary Diagnosis Code/Description and ensure all required fields are filled accurately.
8. For each service requested, list procedure codes separately along with narrative descriptions and any applicable modifiers.
9. Review all entries for completeness before submitting your request through our platform for processing.

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