Florida Department of State and Division of Library and Information Services

Reference: Ref-06750

Reference Name: Direct Reimbursement to Providers and Recipients - Claim Forms
Agency: 59 Agency for Health Care Administration
59G Medicaid

Modified Document(s): No Modified document(s).
Adopted Document(s):
4/20/2016 These forms are to be completed and submitted by providers and recipients for direct reimbursement requests.
Proposed Document(s):
4/18/2016 These forms are to be completed and submitted by providers and recipients for direct reimbursement requests.
Description: These forms are to be completed and submitted by providers and recipients for direct reimbursement requests.

Disclaimer: External links within the reference material are subject to change outside of the rulemaking process.

Rules/Notices using this Reference Material
Notice /
Adopted		 Section Description ID Publish
Date
View Text Final
59G-5.110 		Direct Reimbursement to Recipents 17543437 Effective:
06/02/2016



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