Form FIS0279 Annual Notice of Medicaid Claims - Michigan

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form FIS0279 for the current year.

Form FIS0279 Annual Notice of Medicaid Claims - Michigan

What Is Form FIS0279?

This is a legal form that was released by the Michigan Department of Insurance and Financial Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FIS0279?
A: Form FIS0279 is the Annual Notice of Medicaid Claims for Michigan.

Q: Who receives Form FIS0279?
A: Form FIS0279 is received by individuals who are enrolled in the Medicaid program in Michigan.

Q: What is the purpose of Form FIS0279?
A: The purpose of Form FIS0279 is to provide individuals with a summary of their Medicaid claims for the previous calendar year.

Q: What information is included in Form FIS0279?
A: Form FIS0279 includes information such as the total amount of Medicaid claims paid on behalf of the individual, the types of services received, and any deductibles or copayments paid.

Q: When is Form FIS0279 sent out?
A: Form FIS0279 is typically sent out in the first quarter of the year, after the end of the calendar year for which it provides a summary of claims.

Q: What should I do if I notice any errors on Form FIS0279?
A: If you notice any errors on Form FIS0279, you should contact your Medicaid caseworker or the appropriate agency listed on the form to report the error and request any necessary corrections.

Q: Is Form FIS0279 necessary for filing taxes?
A: While Form FIS0279 provides information about Medicaid claims, it is not necessary for filing taxes. Consult with a tax professional for guidance on reporting Medicaid benefits on your tax return.

Q: Can I request a copy of Form FIS0279 if I didn't receive one?
A: Yes, you can contact your Medicaid caseworker or the appropriate agency listed on the form to request a copy of Form FIS0279 if you did not receive one.

Q: What other documentation may be required for Medicaid eligibility?
A: In addition to Form FIS0279, other documentation such as income verification, identification, and proof of residency may be required for Medicaid eligibility. Contact your Medicaid caseworker for a complete list of required documents.

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Form Details:

  • Released on December 1, 2016;
  • The latest edition provided by the Michigan Department of Insurance and Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FIS0279 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.

Download Form FIS0279 Annual Notice of Medicaid Claims - Michigan

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  • Form FIS0279 Annual Notice of Medicaid Claims - Michigan, Page 1
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