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 FORM B 1R APPLICATION for ANNUAL or TEMPORARY Modot 2019

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Welcome to Module 3, a review of Form CMS-416 Specifications Lines 1a and 1b. This module is part of the CMS web-based training for Form CMS-416 Dental Data Reporting. Please visit the CMS Web-Based Training homepage at Medicaid.gov to find links to modules covering additional topics. There, you will also find a document that contains links to all the resources mentioned in this module. For questions about the Form CMS-416 or the Oral Health Initiative, you can access the complete Form CMS-416 reporting instructions in the Instructions for Completing Form CMS-416 file, posted on the EPSDT page on Medicaid.gov, or email the EPSDT Technical Assistance Mailbox at EPSDT@cms.hhs.gov. This module will cover several learning objectives and additional content related to Form CMS-416 specifications on lines 1a and 1b. After completing this module: You will understand Notes A and B on Page 1 of the Form CMS-416 instructions and how they relate to the dental Lines. You will understand how to calc

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