Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California (Japanese)

Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California (Japanese)

This is a legal form that was released by the California Department of Managed Health Care - a government authority operating within California.

The document is provided in Japanese. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DMHC20-224 form?
A: The DMHC20-224 form is the Independent Medical Review (IMR) Application/Complaint Form.

Q: What is the purpose of the DMHC20-224 form?
A: The purpose of the DMHC20-224 form is to request an independent medical review when there is a dispute regarding a medical necessity determination.

Q: Can I file the DMHC20-224 form in languages other than English?
A: Yes, the DMHC20-224 form is available in languages other than English, including Japanese.

Q: What should I do if I have a complaint or dispute regarding a medical necessity determination?
A: You should fill out the DMHC20-224 form to request an independent medical review (IMR) to resolve the dispute.

Q: Is the DMHC20-224 form specific to California?
A: Yes, the DMHC20-224 form is specific to California and is provided by the California Department of Managed Health Care (DMHC).

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Form Details:

  • Released on August 1, 2018;
  • The latest edition provided by the California Department of Managed Health Care;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form DMHC20-224 by clicking the link below or browse more documents and templates provided by the California Department of Managed Health Care.

Download Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California (Japanese)

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