Reconciliation of State Invoice (ROSI) (CMS-304)

Reconciliation of State Invoice (ROSI) (CMS-304) and Prior Quarter Adjustment Statement (PQRS) (CMS-304a)

Adjustment and Dispute Codes for CMS-304_304a_07.2021_508

Reconciliation of State Invoice (ROSI) (CMS-304)

OMB: 0938-0676