Reporting And Data

Medicaid Hospital Admission, Discharge or Death

Latest Update: August 11, 2020

Reporting Information

Hospitals must report whenever a hospital admission, discharge or death of a Nevada Medicaid patient occurs.

Responsible Party

Who Must Report?

All hospitals


When Do I Report?

Must be submitted within 72 hours of occurrence or notification of pending Medicaid status.


How Do I Report?

Submit Form 3058 to your local Division of Welfare and Supportive Services District Office:

Northern Offices: https://dwss.nv.gov/Contact/Welfare_District_Offices-North/

Southern Offices: https://dwss.nv.gov/Contact/Welfare_District_Offices-South/ 


Why Should I Report?

Failure to submit this form could result in payment delay or denial.


The legal mandate requiring reporting

Nevada Medicaid Services Manual, section 203.2F (Section 203 Page 12)

F. Form 3058 (Admit/Discharge/Death Notice)

All hospitals are required to submit Form 3058 to their local Nevada Division of Welfare
and Supportive Services (DWSS) District Office whenever a hospital admission, discharge
or death occurs.

Current Documents

Documents related to this reporting
Although many of these requirements apply to individual medical professionals and other types of hospitals and health care facilities, the information is presented solely to support Critical Access Hospitals. The reporting requirements and legal mandates on this site are not an exhaustive list and Nevada Rural Hospital Partners, Inc. bears no responsibility or liability for any hospitals' or providers' failure to comply with Federal or State laws or regulations.