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TOWARDS IMPROVED HEALTH
LONG TERM RELATIONSHIPS
Patient letters, H1263B, and referral forms can be downloaded below.
Referral Form Patient Form (Medicaid - Family) Patient Form (Medicaid - No Family) Patient Form (Private Pay)
Nursing facilities residents who have Medicaid with an Applied Income are eligible for dental reimbursement. To establish that the resident has an applied income, the social worker should ask the business office manager. Residents who do not have an applied income are “Full Vendor” residents. Ledet Dental will submit the 1263B after dental work is complete. After Medicaid receives the 1263B, the resident’s Applied Income will be adjusted every month until the dental bill is paid in full.
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