Consumer Choices Option Non Payroll Reimbursement Request Printable Forms Yes No If YES please indicate the admission date and the discharge date Service Date Indicate if service good or cash Must include receipts invoices or purchase order forms Cash if yes Total Dollar Amount Acceptable invoice or proof of payment receipt must be attached to process payment
General Information 2024 Payment Schedule Electronics Services Roles and Responsibilities Background Check Process Q A Enrollment Process Workflow Enrollment EVV Important Info Enrollment Non EVV Important Info Electronic and Copied Signature Guidelines Consumer Choices Option CCO is an Iowa Medicaid program for Iowans with disabilities and aging Iowans CCO allows individuals on Home and Community Based Services HCBS waivers more flexibility over how their services are provided
Consumer Choices Option Non Payroll Reimbursement Request Printable Forms
Consumer Choices Option Non Payroll Reimbursement Request Printable Forms
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Welcome to the Consumer Choices Option CCO program Veridian Fiscal Solutions VFS is a A non payroll reimbursement form is used when you need to be repaid for goods and services Please type or print legibly Last Name First Name Middle Name Maiden Name if applicable Alias if applicable Alias if applicable Alias if The Consumer Choices Option CCO is an option that is available under the Home and Community Based Services HCBS waivers It gives the member control over a targeted amount of Medicaid dollars so that they can develop a plan to meet their needs by directly hiring employees or purchasing other goods and services
We would like to inform you of the Consumer Choice Option CCO which allows you to use providers not available through our health plan while receiving benefits comparable to those you receive when you use in network providers If you choose the CCO your premium will increase 17 5 above your total health care premium Ratios are defined as employee consumer i e 1 2 is 1 employee providing support to 2 consumers 2 1 is 2 employees providing support to 1 consumer It is important to choose the code the includes the correct employee consumer support ratio
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What is CCO Consumer Choices Option Consumer Choices Option is a program that gives Iowans who are eligible for Medicaid Home and Community Based Services HCBS waivers more choice and control in managing their daily lives The Consumer Choices Option program works to improve satisfaction access to care and overall quality of life by This form was developed for the Flexible Choices program to request payments for services goods and cash Topics Consumer Participant Direction Types Tools Policy alerts briefs letters papers Template Form Populations Fiscal Intermediary Personal Assistant Sources Grantee produced Vermont Programs Initiatives Cash and Counseling
FC1 FLEXIBLE CHOICES NON PAYROLL REIMBURSEMENT REQUEST CHECK PAYABLE TO ADDRESS SS CONSUMER NAME Did the consumer have a hospital or nursing home stay during any of these dates Yes No If YES please indicate the dates the consumer was admitted to and discharged from the hospital Non Payroll Reimbursements A non payroll reimbursement form is used to pay vendors This service must be included in the CCO member s service plan and listed as an approved service on the budget All payment requests must include a detailed invoice or receipt Payments Vendors have the choice to be paid through electronic funds transfer
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Yes No If YES please indicate the admission date and the discharge date Service Date Indicate if service good or cash Must include receipts invoices or purchase order forms Cash if yes Total Dollar Amount Acceptable invoice or proof of payment receipt must be attached to process payment
https://www.veridianfiscalsolutions.org/cco/forms.aspx
General Information 2024 Payment Schedule Electronics Services Roles and Responsibilities Background Check Process Q A Enrollment Process Workflow Enrollment EVV Important Info Enrollment Non EVV Important Info Electronic and Copied Signature Guidelines
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Consumer Choices Option Non Payroll Reimbursement Request Printable Forms - We would like to inform you of the Consumer Choice Option CCO which allows you to use providers not available through our health plan while receiving benefits comparable to those you receive when you use in network providers If you choose the CCO your premium will increase 17 5 above your total health care premium
