FORMS
What is the form number of the Request for Information?
DHB-5097 or 5097
True or False:
The template should be filled out with all information on all HH members whether they are applying or not.
False:
Most questions only need information related to applicants.
True or False:
We always need to request residency verification.
False:
We accept client statement if no verifications are found.
What is the DHB-5200?
Medicaid Application, application for health coverage
True or False:
Items like retro and emergency can be left of the template if they do not apply to your application
False:
ALL information must be filled in on the template.
How many calendar days must be between the first notice (5097) and the second notice?
12
What is the form we send with the DHB-5097 to get resource information?
Appendix D, DHB-5202C
What is the first item on the documentation template?
CHANGE CASE OWNER NAME!
What is the time period for requesting medical bills for a deductible?
24 MONTHS or month of app minus 2 years
What is the number of the form used for application approvals?
5003/DHB-5003
At application, where does documentation need to be entered?
In compass and on all applications.
True or False:
If the 12th day falls on a weekend or holiday, the 2nd notice can be sent on the next business day.
True