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DOM Form 1166 C Notice of Hospice Election or Discharge for Dual Eligible Beneficiaries - Mississippi
What Is DOM Form 1166 C?
This is a legal form that was released by the Mississippi Division of Medicaid - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 1166 C?
A: Form 1166 C is the Notice of Hospice Election or Discharge for Dual Eligible Beneficiaries.
Q: What is a dual eligible beneficiary?
A: A dual eligible beneficiary is someone who is eligible for both Medicare and Medicaid.
Q: What is the purpose of Form 1166 C?
A: The purpose of Form 1166 C is to notify Medicare and Medicaid of a dual eligible beneficiary's election or discharge from hospice care.
Q: Who should use Form 1166 C?
A: Form 1166 C should be used by hospices when notifying Medicare and Medicaid of a dual eligible beneficiary's election or discharge.
Q: Is Form 1166 C specific to Mississippi?
A: No, Form 1166 C is not specific to Mississippi. It is used nationwide for dual eligible beneficiaries.
Q: Are there any fees associated with submitting Form 1166 C?
A: No, there are no fees associated with submitting Form 1166 C.
Q: What should I do if I have questions about Form 1166 C?
A: If you have questions about Form 1166 C, you should contact your local Medicare and Medicaid offices for assistance.
Form Details:
- Released on April 1, 2021;
- The latest edition provided by the Mississippi Division of Medicaid;
- 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 DOM Form 1166 C by clicking the link below or browse more documents and templates provided by the Mississippi Division of Medicaid.
