Contracted and Non-Contracted Inpatient Services (cont ip)

INPATIENT REHABILITATION. Initial Request. Required . Service Authorization. Information. Provider contact name: Provider contact number: Out of state providers, located close to the proximity of the VA State line and who are enrolled with Virginia Medicaid as a provider class type 085 (Out of State Rehab Hospital) need to determine and document evidence that one of the following items are met ... ................
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