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DISPROPORTIONATE SHARE OBSTETRICAL STATEMENT RATE YEAR 2006 COMPLETE EITHER PART I OR PART II PART I To be completed only by those hospitals providing non-emergency obstetrical services to the general public. The following obstetricians have staff privileges at the hospital named below and have agreed to provide nonemergency obstetrical services for Illinois Medicaid beneficiaries Physician s Name Typed Additional names may be submitted as an att...
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How to fill out disproportionate share obstetrical statement
How to fill out disproportionate share obstetrical statement:
01
Obtain the required form from the appropriate authority or agency.
02
Read and understand the instructions provided with the form to ensure accurate completion.
03
Enter the relevant information in the designated fields, such as the healthcare provider's name and contact details, the patient's information, and the specific services provided.
04
Provide details on the patient's eligibility for Medicaid or other government healthcare programs, as well as any relevant diagnosis codes.
05
Fill in the financial information accurately, including the patient's income and any insurance coverage.
06
Include any additional documentation or supporting evidence, such as medical records, to strengthen the statement's validity.
Who needs disproportionate share obstetrical statement:
01
Hospitals or healthcare providers that serve a high number of Medicaid or uninsured patients.
02
Providers seeking reimbursement or additional funding for obstetrical services provided to low-income patients.
03
Organizations or entities that require documentation of the provider's efforts to serve underserved populations in the community.
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What is disproportionate share obstetrical statement?
Disproportionate share obstetrical statement is a document that reports information related to the provision of obstetrical services to low-income patients by qualifying hospitals.
Who is required to file disproportionate share obstetrical statement?
Qualifying hospitals that provide obstetrical services to low-income patients are required to file the disproportionate share obstetrical statement.
How to fill out disproportionate share obstetrical statement?
To fill out the disproportionate share obstetrical statement, hospitals need to provide detailed information about the obstetrical services they have provided to low-income patients, including the number of patients served and the associated costs.
What is the purpose of disproportionate share obstetrical statement?
The purpose of disproportionate share obstetrical statement is to ensure that qualifying hospitals that provide obstetrical services to low-income patients receive appropriate reimbursement for their services.
What information must be reported on disproportionate share obstetrical statement?
The disproportionate share obstetrical statement must include information such as the number of low-income patients served, the types of services provided, the costs involved, and any other relevant details.
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