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Form F-10099 Notice of State Authorized Placement of a Medicaid Recipient in an Out-of-State Treatment Facility - Wisconsin
What Is Form F-10099?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F-10099?
A: Form F-10099 is a notice of state authorized placement of a Medicaid recipient in an out-of-state treatment facility in Wisconsin.
Q: Who receives Form F-10099?
A: The recipient and the out-of-state treatment facility receive Form F-10099.
Q: Why is Form F-10099 used?
A: Form F-10099 is used to notify the recipient and the out-of-state treatment facility about the state authorized placement of a Medicaid recipient.
Q: What information is included in Form F-10099?
A: Form F-10099 includes the recipient's name, Medicaid ID, placement dates, treatment facility information, and contact information.
Q: Is Form F-10099 specific to Wisconsin?
A: Yes, Form F-10099 is specific to Wisconsin as it is used to notify recipients and facilities about out-of-state placement within the state.
Q: Can a Medicaid recipient be placed in an out-of-state treatment facility without authorization?
A: No, the placement of a Medicaid recipient in an out-of-state treatment facility requires state authorization, as indicated in Form F-10099.
Q: What should a recipient do upon receiving Form F-10099?
A: Upon receiving Form F-10099, a recipient should review the information and contact the treatment facility or their caseworker if they have any questions or concerns.
Q: Can a recipient refuse placement in an out-of-state treatment facility?
A: A recipient can discuss any concerns or preferences regarding out-of-state placement with their caseworker, but the final decision is ultimately based on state authorization.
Q: Is out-of-state treatment covered by Medicaid?
A: In most cases, out-of-state treatment is covered by Medicaid, but it is always recommended to verify coverage with the Medicaid program.
Q: Are there any costs associated with out-of-state treatment for Medicaid recipients?
A: Medicaid may cover the costs of out-of-state treatment, but the recipient may still be responsible for co-pays or other applicable fees.
Form Details:
- Released on July 1, 2008;
- The latest edition provided by the Wisconsin Department of Health 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 F-10099 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
