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How to prepare Form 8484

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What Is Form 8484?

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How to complete a form 8484?

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FAQ - Form 8484

What is the purpose of Form 8484?
The “8” in the form should be replaced by the year and, typically, add or subtract. You can get the Form 8485 and 8486 from the Federal Government or by contacting the appropriate state Medicaid office. [17] Included in the Form 8485 will be forms for your health care provider (generally, a Physician or a physician assistant, or sometimes an internist, nurse, or physician) and for employers, such as your employer or the insurance company. A copy of the information for the employers will also be included. Health insurance coverage in Alaska is through an HMO (Community Health Organization). The form has instructions for completing the 8473 form with the health insurer, and it also gives the name of the provider for the state and the county where you live, so you need to make sure the information you give the insurer is correct. [18] You can get the 8473 form from Kaiser, Alcoa, or Alaska Health Options [19] with a copy of the Alaska State Registry of Health Plans. For this form, your health insurance company, health care provider, and employers are listed as the parties you will be dealing with. If your Medicare or Medicaid provider (or employers) won't sign the 8473, you will also need to get a Medicare number and a Social Security number. (The Social Security number for the non-Medicaid provider can be found in this form.) Once you have these, mail the 8473 and its required documents to the Alaskan Medicaid Office, and they will send a copy of the 8473 letter with the form to the health insurer. They can also send you a letter with the required documentation by mail. If one or more of the documents from the 8473 does not come up, the Medicaid office will ask for additional information from you. If all the documentation required is not in the 8473, you will need to fill out the form again (not the form 8484) and pay a 15 fee (45 in Alaska). A 5 fee will be added for the form 8484. If you have a valid card, but you don't have a Medicare or Medicaid number, you can still get Medicaid in Alaska.
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