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Form - FP170 JN PARD provider master information

This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations.

HRSA Covid 19 Attestation

View this HRSA COVID-19 attestation.

Payment Rate Calculation Form

THIS IS A DOCUMENT

RHC FQHC Vaccine cost projection request form

THIS IS A DOCUMENT

Flowchart - Modifier 24

Use this decision flowchart to assist in correctly applying the 24 modifier.

Flowchart - Modifier 25

Use this decision flowchart to assist in correctly applying the 25 modifier.

Flowchart - Modifier 57

Use this decision flowchart to assist in correctly applying the 57 modifier.

Flowchart - Modifier 58

Use this decision flowchart to assist in correctly applying the 58 modifier.

Flowchart - Modifier 78

Use this decision flowchart to assist in correctly applying the 78 modifier.

Flowchart - Modifier 79

Use this decision flowchart to assist in correctly applying the 79 modifier.