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Get and Sign MS 2126 NOTIFICATION of FACILITY ADMISSIONDISCHARGE 2016 Form

Get and Sign MS 2126 NOTIFICATION of FACILITY ADMISSIONDISCHARGE 2016 Form

Use a MS 2126 NOTIFICATION OF FACILITY ADMISSIONDISCHARGE 2016 template to make your document workflow more streamlined.

Distribution Original to Facility Copy to Kancare Clearinghouse. MS-2126 Instructions 1. The facility initiates the MS-2126 under the conditions specified in KEESM 8184. For PRTF follow processing guidelines outlined in the appropriate KMAP provider manual regarding prior authorization and prescreening. MS-2126 NOTIFICATION OF FACILITY ADMISSION/DISCHARGE Rev 07-2016 I. RESIDENT INFORMATION Name SSN Date of Birth Sex Client ID Responsible Person or Agency Relationship II. 8. The Kancare...
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