Medicaid

Question 1

Your Application for Medicaid is Pending

Answer 1

DHB-5098

Question 2

Accident Information Report

Answer 2

DHB-2043

Question 3

Request for Information for Evidence to determine Good Cause

Answer 3

DHB-5097 (20 Calendar Days)

Question 4

Request for Good Cause “Second Notice of Right to Claim Good Cause for Refusal to Cooperate with Child Support Enforcement” (20 days to comply)

Answer 4

DSS-8104

Question 5

IV-D Referral

Answer 5

Child Support Referral for Medical Assistance. Goes to CSS

Question 6

Notice for when a positive change of benefit ex. extension of benefit eligibility period

Answer 6

Adequate DSS-8110

Question 7

Notice for when there is usually when there is a negative change to benefit ex. termination of benefit

Answer 7

Timely DSS-8110

Question 8

Newborn Approval Notice

Answer 8

DHB-5000

Question 9

Request For Information Once Pregnancy Ends

Answer 9

DHB-5097

Question 10

Newborn birthed at Hospital- Notice of Authorized Auto Newborn (mailed only to hospital)

Answer 10

DMA-5020

Question 11

Notice of Change of Benefits

Answer 11

DSS-8110

Question 12

Good Cause Information

Answer 12

NCF-22000

Question 13

Pregnancy Home Information

Answer 13

DMA-5076

Question 14

Transportation Request Form

Answer 14

DHB-5046

Question 15

Carolina Access Benefits of being a Member- Managed Care

Answer 15

DMA-9016

Question 16

Denied for Failure to Provide Information

Answer 16

DSS-8109

Question 17

Medicaid Program Approval Notice

Answer 17

DHB-5003- Not Populated by NC Fast

Question 18

Request for Information (Usually 12 days)

Answer 18

DHB- 5097

Question 19

Designation or Authorized Representative Form

Answer 19

DMA- 5202-c

Question 20

Application for Health Coverage

Answer 20

DMA- 5200

Question 21

DHB-5098

Answer 21

Your Application for Medicaid is Pending

Question 22

DHB-2043

Answer 22

Accident Information Report

Question 23

DHB-5097 (20 Calendar Days)

Answer 23

Request for Information for Evidence to determine Good Cause

Question 24

DSS-8104

Answer 24

Request for Good Cause “Second Notice of Right to Claim Good Cause for Refusal to Cooperate with Child Support Enforcement” (20 days to comply)

Question 25

Child Support Referral for Medical Assistance. Goes to CSS

Answer 25

IV-D Referral

Question 26

Adequate DSS-8110

Answer 26

Notice for when a positive change of benefit ex. extension of benefit eligibility period

Question 27

Timely DSS-8110

Answer 27

Notice for when there is usually when there is a negative change to benefit ex. termination of benefit

Question 28

DHB-5000

Answer 28

Newborn Approval Notice

Question 29

DHB-5097

Answer 29

Request For Information Once Pregnancy Ends

Question 30

DMA-5020

Answer 30

Newborn birthed at Hospital- Notice of Authorized Auto Newborn (mailed only to hospital)

Question 31

DSS-8110

Answer 31

Notice of Change of Benefits

Question 32

NCF-22000

Answer 32

Good Cause Information

Question 33

DMA-5076

Answer 33

Pregnancy Home Information

Question 34

DHB-5046

Answer 34

Transportation Request Form

Question 35

DMA-9016

Answer 35

Carolina Access Benefits of being a Member- Managed Care

Question 36

DSS-8109

Answer 36

Denied for Failure to Provide Information

Question 37

DHB-5003- Not Populated by NC Fast

Answer 37

Medicaid Program Approval Notice

Question 38

DHB- 5097

Answer 38

Request for Information (Usually 12 days)

Question 39

DMA- 5202-c

Answer 39

Designation or Authorized Representative Form

Question 40

DMA- 5200

Answer 40

Application for Health Coverage