View ACF COVID-19 Responses and Resources
The State Interstate Match Contact is for states, Puerto Rico and the District of Columbia, to post contact information for interstate communication to assist in resolving matches. This is to augment the contact information already provided within each interstate match, and to reduce contact to PARIS State Administrative Representatives.
States looking to update their interstate match contact information should email requests to PARIS@acf.hhs.gov. All requests for updates should either come from or cc the applicable State Administrative Representative(s).
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: First attempt contact to phone number or fax number in file Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) ii. Phone: ______ B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) iii. FAX: 860-424-5333 B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: FAX only requests. Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) ii. Phone: ______ B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: "Out-of-State Inquiry" in subject line, include your contact information. Include the names and date of birth for household members and their last 4 digits of SSN. List current address for household and date it was reported to your state. Expect an email response within 5 business days. Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions:
Last Updated: March 14, 2018
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Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: September 22, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: More information is available at https://www.myflfamilies.com/service-programs/access/out-of-state-inq... Last Updated: October 20, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: July 29, 2019 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: To determine if individual is still on Hawaii Medicaid, use the contact information on the PARIS file. If no response contact Kimberly Lutao at klutao@dhs.hawaii.gov or (808) 587-7291 Last Updated: April 2, 2019 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: For SNAP fraud investigations contact W. Nicola at wnicola@dhs.hawaii.gov or (808) 587-7291 Last Updated: April 2, 2019 |
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: February 3, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: May 20 2019 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Need client zipcode to be routed Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: For PARIS inquiries sent via Fax, please specify "ATTN: PARIS TEAM" on the cover sheet. Out of State inquiries not related to a PARIS match should be sent to: DCF.EBTMAIL@ks.gov Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions:
Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: June 11, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: November 19, 2019 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: If you do not receive a response from the contact listed in the data match within 5 business days, contact Gina Roberts (410) 238-3550 or Gina.Roberts@maryland.gov Please provide how you want information received back, either email or fax. Last Updated: December 3, 2018
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions:
Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: November 19, 2019 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: November 19, 2019 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: October 5, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: When contacting Minnesota, please put "PARIS Inquiry" in the subject line and provide the clients name, DOB and SSN. Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: First attempt contact to phone number or fax number in file Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Faxed requests for coverage verification should be submitted on letterhead. Last Updated: October 14, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) ii. Phone: ______ B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: May 24, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Request must be from official government email address. No faxed request accepted. Include full name, DOB and the last 4 of SSN in your request. Last Updated: June 3, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Request must be from official government email address. No faxed request accepted. Include full name, DOB and the last 4 of SSN in your request. Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: PARIS email inquiries must include the requestor’s signature lines with titles Last Updated: September 24, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: November 16, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Contact is county switchboard – ask to speak to interstate match worker. Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: May 18, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Oklahoma Health Care Authority is secondary contact for on-line enrollment medical Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Cover PARIS matches for Oklahoma Medicaid Online enrollment only Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Match first two digits of record # with county on list. Last Updated: August 3, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: August 18, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: All inquiries should be sent with Complete SS#. Last Updated: August 18, 2020 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: October 1, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Fraud and PARIS matches handled by Keshawn Jacobs at Keshawn.Jacobs@dss.sc.gov Last Updated: October 1, 2020 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Place Paris Match in subject line. Include the begin date of eligibility and current mailing address. Last Updated: August 18, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: This contact is for verification ONLY if a termination is needed fax that request to 615-532-5236. Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Fax must be on your agency letterhead. Please submit one inquiry per page. Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Medical Assistance: #1 Email, #2 FAX, #3 Phone Contact Format used by State: (Answer for either A or B, but not both.) TANF and SNAP B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: July 29, 2020 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: PARIS inquiries need to include a current mailing address and application date. Last Updated: November 08, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: May 18, 2020 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: June 18, 2020 |
Primary Contact Resource
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Secondary Contact Resource
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Note: The State Interstate Match Contact web page can list up to two separate contact groups per state, e.g., one for TANF/FS and secondary for MA. Submit a separate page for each contact.
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Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |
Program Support via Contact Point (check all that apply): Preferred Contact Method: (Rank contact methods from #1 to #3; #1 being preferred.) Contact Format used by State: (Answer for either A or B, but not both.) B. Multiple contact points: C. Contact for benefit redemption history/medical claims history if different from above: Special Instructions: Last Updated: March 14, 2018 |