alaska medicaid xerox cmn
Aug 8, 2003 … http://manuals.medicaidalaska.com/physician/print.htm ….. The CMN may be
used for most DME, supplies, prosthetics and orthotics, audiology …. A copy of
the CLIA certificate must be on file with Xerox (refer to Provider …
Aug 24, 2015 … Alaska Medicaid Member ID: Date of Birth … Xerox Use Only. Approved: …
Submitted by: Enter the name of the individual submitting the CMN.
CENTERS FOR MEDICARE & MEDICAID SERVICES. Form Approved ….
Whether submitting a REVISED or a RECERTIFIED CMN, be sure to always
furnish the …