Documentation For DCH File Transfer: sent via Fax or DCH Policy title / specific List file name submitted File Transfer Documentation Required page numbers that as evidence for the (Check appropriate address indicator indicator box) MDHHS fiscal year as identified by MDHHS Reviewer. 1. Five copies of signed BCCCNP clinical service provider contracts [ ] Fax ONLY Not Applicable or letters of agreement from last Indicator 8.2 Assure that providers are provided a copy of the BCCCNP Unit Cost Reimbursement Rate Schedule which indicates the maximum rates for BCCCNP screening and diagnostic services. Providers may bill the MDHHS Cancer Prevention and Control Section billing service up to the usual and customary charge; however, the reimbursement amount, will not exceed the BCCCNP approved rates. List file name submitted as evidence for the indicator Documentation Required Policy title / specific page numbers that address indicator MDHHS sent via Fax or DCH File Transfer (Check appropriate box) For DCH File Transfer:
Documentation Required MDHHS Documentation sent via Fax or DCH File Transfer (Check appropriate box) For DCH File Transfer: List file name submitted as evidence for the indicator Policy title / specific page numbers that address indicator 1. Five copies of signed BCCCNP clinical service provider contracts or letters of agreement from last fiscal year as identified by MDHHS Reviewer. [ ] Fax ONLY Not Applicable Indicator 8.2 Assure that providers are provided a copy of the BCCCNP Unit Cost Reimbursement Rate Schedule which indicates the maximum rates for BCCCNP screening and diagnostic services. Providers may bill the MDHHS Cancer Prevention and Control Section billing service up to the usual and customary charge; however, the reimbursement amount, will not exceed the BCCCNP approved rates. Documentation Required MDHHS sent via Fax or DCH File Transfer (Check appropriate box) For DCH File Transfer: List file name submitted as evidence for the indicator Policy title / specific page numbers that address indicator