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Revision History Document Date Version Name Comments 1.0 04/27/2010 EDI Created. 1.1 06/09/2010 Suzanne Willson Ron Chandler Revised per request. 1.2 06/10/2010 Suzanne Wilson Ron Chandler Removed PHI from images. 1.3 10/8/2010 Stayce Towles Updated 1.4 10/5/2010 Stayce Towles Ron Chandler Revised. 1.5 10/14/2010 Stayce Towles Ron Chandler Revised. 1.6 10/18/2010 Martha Senn Ron Chandler DMS approved 10/18/2010. 1.7 12/08/2010 Ann Murray Global corrections and changes. 1.8 12/09/2011 Brenda Orberson Ann Murray Updated screen shots. Pg. 90, field 14 – changed EPSDT/Family Planning to EPSDT 12/15/2011 1.9 02/14/2013 Martha Senn Keri Hicks CO 19321 – Updated Member Eligibility Verification screen and the Managed Care 5 year History screen. CO 19280 – Inserted Adjusted Primary Care Attestation screens. 2.0 02/14/2013 Keri Hicks Finalized Tech Writer Updates. DMS Approved 02/14/2013. 2.1 02/26/2013 Martha Senn Update to Adjusted Primary Care Attestation information by provider type. 2.2 03/04/2013 Keri Hicks Finalized Tech Writer Updates. DMS Approved 03/01/2013. 2.3 6/20/2013 Martha Senn CO – 19925 Update to Adjusted Primary Care Attestation screen shot eligibility period for adjusted rates.
