The Department of Health Care Finance (DHCF's) 719A form is used to request an authorization for medical/surgical service(s), for the FeeforService (FFS) Medicaid beneficiaries The 719A has been revised, and will be in effect starting The new 719A form incorporates the CMS requirement that a physician or nurse practitioner certify a facetofaceHome Health Face to Face Checklist General Is the encounter performed within the time frame (90 days before 30 days after)?Facetoface encounter that meets the home health physician facetoface encounter requirements with this patient on Date patient was seen Month The encounter with the patient was in whole, or in part, for the following medical condition, which is the
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Face to face form pdf