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  • Nc Amerihealth Caritas Facility Data Intake Form

Get Nc Amerihealth Caritas Facility Data Intake Form

Lling Typ pe: Name Doing Business As (if applicable): W-9 TIN/E EIN (nine charracters): Primary C Contact Name: UB-04/Instittutional N NCTracks P Provider ID: Primary Contac ct Email: Addres ss Line 1 CMS-15 500/Professional Primary Contact Phone: Addresss Line 2 City State ZIP + 4 Digits T Telephone ( (with Area Code) ddress Pay to Ad Recoveries Address Same e as Pay To Address s Organization Website: Section 2 Instructions: Please complete each e section below w for.

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How to fill out the NC AmeriHealth Caritas Facility Data Intake Form online

This guide provides detailed instructions on how to effectively complete the NC AmeriHealth Caritas Facility Data Intake Form online. Follow these steps to ensure that all required information is accurately submitted, facilitating a smooth intake process.

Follow the steps to successfully complete the online form.

  1. Use the ‘Get Form’ button to access the NC AmeriHealth Caritas Facility Data Intake Form and open it in your chosen editor.
  2. Begin by filling out Section 1, which includes the provider's entity name as it appears on the W9 form, the IPA name if applicable, billing type, and the name doing business as, if relevant. Ensure that you complete all required fields.
  3. Enter the W-9 Tax Identification Number (TIN)/Employer Identification Number (EIN) accurately, followed by the primary contact name and email address. Include the address details explicitly, comprising Address Line 1, Address Line 2, city, state, and ZIP + 4 digits.
  4. Input the primary contact phone number including area code and the recovery address, if necessary. Fill in the organization website if available.
  5. In Section 2, provide information for all practice locations, listing each location number followed by the facility name, address details, county, and facility NPI or Atypical ID as appropriate.
  6. Detail the office hours for each practice location. Indicate whether each day is open or closed, and the specific opening and closing times if applicable.
  7. For Section 3, assess and indicate the ADA compliance for each listed location. Use checkboxes to represent whether the building is compliant in areas like accessible medical equipment and restroom access.
  8. Move to Section 4 where you will specify the services provided at each location, as well as the age groups served. Mark each service provided appropriately for each practice location.
  9. After thoroughly completing the form, review all entries for accuracy. When satisfied, save your changes. You can then download, print, or share the completed form as required.

Complete your NC AmeriHealth Caritas Facility Data Intake Form online today to ensure a smooth processing experience.

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In North Carolina, the timely filing limit for Medicaid claims is generally 12 months from the date of service. Understanding this timeline helps you prepare and submit claims effectively. For precise guidance and processing, the NC AmeriHealth Caritas Facility Data Intake Form may be beneficial.

To apply for AmeriHealth Caritas in Pennsylvania, you can visit their official website for an application form or use local resources for assistance. Make sure to gather the necessary documentation to expedite the process. As a helpful tool, the NC AmeriHealth Caritas Facility Data Intake Form can assist with submissions and data management.

The timely filing limit can vary by provider and service type but is often set at 12 months for Medicaid-related claims. It's essential to check with your specific provider for the exact timeline to avoid issues. For more clarity and efficient filing, consider the NC AmeriHealth Caritas Facility Data Intake Form.

For appeals with AmeriHealth Caritas NC, the timely filing limit is generally 60 days from the date of the initial determination. It's essential to adhere to this timeframe to ensure your appeal is reviewed properly. If you require assistance with the appeal process, consider utilizing the NC AmeriHealth Caritas Facility Data Intake Form for streamlined handling.

To contact AmeriHealth Caritas NC, you can call their customer service number listed on their website or send them an email through the contact page. They are available to address your questions and concerns promptly. Additionally, when reaching out, references to the NC AmeriHealth Caritas Facility Data Intake Form can help clarify your specific needs.

Finding a provider within the AmeriHealth Caritas NC network is simple. You can visit their website and utilize the provider directory tool, which lists participating healthcare professionals. You may also contact customer support for direct assistance. Utilizing the NC AmeriHealth Caritas Facility Data Intake Form can help streamline the provider selection process.

Yes, AmeriHealth Caritas operates as a managed care organization under NC Medicaid. They provide health insurance services for residents who qualify for Medicaid. This organization focuses on delivering care to meet the specific needs of its members. If you need access to their services, the NC AmeriHealth Caritas Facility Data Intake Form is a great starting point.

Finding your NC Medicaid ID number can be done by checking your Medicaid card or calling the NC Medicaid Customer Service. Alternatively, you may access your online account if you have registered with NC Medicaid. To facilitate your paperwork, keep handy the NC AmeriHealth Caritas Facility Data Intake Form, which may require this number.

You can email AmeriHealth Caritas NC by navigating to their official website and accessing the contact section. Here, you will find the appropriate email address based on your inquiry. For specific information about the NC AmeriHealth Caritas Facility Data Intake Form, mentioning it in your email can streamline their response.

The timely filing limit for submitting claims to AmeriHealth Caritas of NC typically extends to 90 days from the date of service. It is essential to file within this period to ensure reimbursement. Keeping track of your submissions helps avoid delays. For easier management of your health claims, consider using the NC AmeriHealth Caritas Facility Data Intake Form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232