Form HCA13-0103 Medicaid Attestation Form on the Appropriateness of the Qualified Clinical Trial - Washington

What Is Form HCA13-0103?

This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the HCA13-0103 Medicaid Attestation Form?
A: The HCA13-0103 Medicaid Attestation Form is a form used in Washington for attesting to the appropriateness of a qualified clinical trial for Medicaid coverage.

Q: What does the form require?
A: The form requires the provider to provide information about the patient, the clinical trial, the treating physician, and the consent process.

Q: Who needs to complete the form?
A: The form needs to be completed by the provider who is responsible for coordinating and overseeing the qualified clinical trial for the patient.

Q: What is the purpose of the form?
A: The purpose of the form is to verify that the clinical trial meets the requirements for Medicaid coverage and to ensure appropriate billing and reimbursement.