CHOW Time
This DYP category can submit a CHOW.
What is Entity?
Where OOS providers must be geographically located.
What is more than 50 miles from the FL border?
The acronym for the crossover claims form.
What is EOMB (Explanation of Medicare Benefits)?
The tax proof is ALWAYS verified in these panels.
What is Identifying Information and Address Details?
The assignee for RAI'd applications.
What is unassigned?
This is the MOST common document that must be submitted with ALL CHOW applications.
What is a Bill of Sale?
This PT cannot enroll as an OOS provider.
What is PT 39 (Behavioral Analysis)?
The letter accompanying the crossover app must state compliance with which laws, rules, and policies.
What is Medicaid and Medicaid?
Important PE processing info in the Taxonomy panel
What is the PT and Specialty?
The three MPA versions.
What is Non-Institutional, Institutional, Crossover?
This panel in DYP determines whether the provider submitted a CHOW.
What is the Identifying Information panel?
This is the claim form is used by facilities.
What is the UB-04?
The type of claims associated with crossover applications.
What is Dual Eligible?
The recipient must be enrolled in both Medicare and Medicaid.
All individuals which access to Medicaid funds are listed here.
What is Key Personnel?
What are Sole Proprietor and Sole Proprietor enrolling as a member of a group?
This type of individual PT can submit a CHOW.
What is none?
Only Entity (Group/Facility) providers can submit CHOWs
This DYP panel determines an OOS application.
What is the Service Address panel?
The documents that must be submitted for Crossover applications.
All docs required for the PT plus:
The type and total percentage of ownership when required.
What is 100% Direct ownership?
This PT has no Taxonomy.
What is PT 99 (Trading Partners)?
This is the "CHOW"-specific information that must be verified in DYP.
What is prior owner name, NPI, and FEIN?
Which four PTs CANNOT submit an OOS application.
What is PT 20, PT 39, PT 50, and PT 90?
The DYP panel that indicates a Crossover application.
What is the Provider Identifiers panel?
The DYP status that indicates the application has been sent to QC.
What is pending approval?
This practice type may require an affiliation.
What is a Group?