Form CMS-304a Prior Quarter Adjustment Statement (PQAS)

Reconciliation of State Invoice (ROSI) (CMS-304) and Prior Quarter Adjustment Statement (PQRS) (CMS-304a)

CMS Form-304a Prior Quarter Adjustment Statement (PQAS)_07.2021_508

Prior Quarter Adjustment Statement (PQAS) (CMS-304a)

OMB: 0938-0676