Crosswalk: Provider HSD Table

Provider HSD Crosswalk OMB 0938-1346 090622.xlsx

Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)

Crosswalk: Provider HSD Table

OMB: 0938-1346

Document [xlsx]
Download: xlsx | pdf
# Form Change Current Location Reason
1 Provider HSD Table Addition of the column "Letter of Intent Y/N" to the Provider HSD Table Template, Column O New- Column O Provider HSD Table Template CMS-4192-F includes procedural changes to network reviews based on an MAO's status (applicant versus triennial), initial applicants and service area expansion applicants may use a letter of intent for purposes of network adequacy during the application process. The column is included on the provider HSD table for both applicant and triennial network submissions, however the completion of the column is optional and will not prohibit the organization from uploading in the Network Management Module if left blank.
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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