TX HHS Form H3618-A. Resident Transaction Notice for Designated Vendor Numbers

The Resident Transaction Notice for Designated Vendor Numbers (Form H3618-A) is a crucial document that helps facilitate the transfer of assets between Medicaid recipients and designated vendors. This form is typically used in situations where a resident's assets are being transferred from one vendor to another, such as when moving from a nursing facility to a new residence.

The form requires specific information, including the Medicaid recipient number, social security number, Medicare or Railroad Retirement claim number, name of the recipient, and designated vendor numbers. It also includes a section for noting the transaction date and any relevant comments. The MEPD Specialist is responsible for completing this form and providing their signature and employee number.

Key features of this form include the requirement to complete the discharge from one vendor and admission to another on the same date, as well as the need to provide a valid reason for the transfer. This form helps ensure that Medicaid recipients' assets are properly transferred and accounted for, and it provides a clear record of the transaction. Here are some key points to keep in mind:

• The form is used to facilitate the transfer of assets between Medicaid recipients and designated vendors.
• It requires specific information about the recipient and the transaction.
• The MEPD Specialist is responsible for completing the form.