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Get and Sign Application for Disproportionate Share Hospital Program Dsh and Medicaid Kchip Screening Form 2013-2022

Get and Sign Application for Disproportionate Share Hospital Program Dsh and Medicaid Kchip Screening Form 2013-2022

Create a custom kchip application 2013 that meets your industry’s specifications.

Eligibility determination. Section 1: Individual Information 1. 2. 3. 4. Today’s Date: Patient’s Name: Street Address: City: State: Zip Code: 5. *Social Security Number: 6. Date of Birth: 8. 9. Work Phone: 10. Dates Hospital Provided Service: 11. Married/Single: 12. Name of Spouse: 13. Is the patient pregnant? Yes No If YES, refer the patient to DCBS for Medicaid eligibility determination 7. Patient’s Sex: 14. Is the patient a resident of Kentucky? Yes No (“Resident” is defined as a...
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Reimbursement disproportionate share payments that include adjustments to reflect the costs of uncompensated care and higher costs for inpatient care for certain populations receiving mandated services Medicare and Medicaid include provisions for this type of reimbursement

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