CSHCS-Medicaid Reimbursement Billing Support Spreadsheet A B C D E F G H I J K L M PHN Date of Date of Date of Date of Date of Date of Date of Medicaid HHLPSS ID Last Name First Name Home Home Home Home Home Home Comments ID Initials Visit Visit Visit Visit Visit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 12/07/16
CSHCS-Medicaid Reimbursement Billing Support Spreadsheet A B C D E F G H I J K L M 1 HHLPSS ID Last Name First Name Date of Medicaid ID PHN Initials Date of Home Visit Date of Home Visit Date of Home Visit Date of Home Date of Home Visit Date of Home Visit Comments 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 12/07/16