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  • Oh Amerihealth Caritas Facility Data Intake Form

Get Oh Amerihealth Caritas Facility Data Intake Form

Name Doing Business As (if applicable): W-9 TIN/EIN (nine characters): Primary Contact Name: UB-04/Institutional State Medicaid ID: Primary Contact Email: Address Line 1 CMS-1500/Professional Primary Contact Phone: Address Line 2 City State ZIP + 4 Digits Telephone (with Area Code) Pay to Address Recoveries Address Same as Pay To Address Organization Website: Section 2 Instructions: Please complete each section below for all locations including applicable NPI or Atypical ID inform.

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How to use or fill out the OH AmeriHealth Caritas Facility Data Intake Form online

Filling out the OH AmeriHealth Caritas Facility Data Intake Form online can be a straightforward process when you have the right guidance. This user-friendly guide will walk you through the necessary steps to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

  1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
  2. Begin by entering the entity name exactly as it appears on the W-9 form. Include the IPA name if it is applicable to your organization. Select the appropriate billing type and provide the 'Doing Business As' name if relevant.
  3. In Section 2, continue by listing all facility locations. For each practice location, provide the facility name as it appears in the provider directory, along with the complete address details.
  4. For Section 3, indicate ADA compliance status for each location. Clearly mark whether each location accommodates people with various disabilities, using the numbered options presented.
  5. In Section 4, select the services provided at each location by checking the appropriate boxes and noting the ages served for those services. For unlisted services, make sure to specify and indicate relevant details.
  6. Finally, save your changes, then download, print, or share the completed form as necessary to ProviderEnrollmentOH@amerihealthcaritas.com.

Complete your OH AmeriHealth Caritas Facility Data Intake Form online today to ensure a smooth submission process.

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The timely filing limit for AmeriHealth Caritas Ohio mirrors the general standard of 90 days from the date of service. Submitting your claims within this deadline is critical to avoid payment denials. Ensuring your OH AmeriHealth Caritas Facility Data Intake Form is completed accurately can help you stay on track with these time-sensitive submissions.

To email AmeriHealth Caritas Ohio, you can visit their website to access their contact page. Look for the email address provided for customer inquiries or claims support. When sending your email, ensure that you reference your OH AmeriHealth Caritas Facility Data Intake Form to streamline the communication process.

The payer ID for AmeriHealth Caritas Ohio is specific to facilitate accurate claims processing. It is essential to reference the correct payer ID when submitting the OH AmeriHealth Caritas Facility Data Intake Form to ensure timely reimbursement. You can find this information readily available on their official website or contact their customer service for assistance.

The timely filing limit typically refers to the period within which claims must be submitted for reimbursement. For OH AmeriHealth Caritas Facility Data Intake Form, this limit is usually within 90 days from the date of service. It's crucial to submit your claims within this timeframe to ensure processing and avoid delays in payment.

To find a provider on AmeriHealth Caritas NC, navigate to the provider directory available on their official website. You can search for healthcare professionals by specialty or location. Additionally, using the OH AmeriHealth Caritas Facility Data Intake Form may offer insights into provider options in your area. Finding the right provider is essential for accessing quality care.

Yes, AmeriHealth Caritas Ohio operates as a managed care plan under the Ohio Medicaid program. This means it serves low-income residents, providing access to necessary healthcare services. For further details on enrollment and benefits, it is advisable to refer to the OH AmeriHealth Caritas Facility Data Intake Form. You can gain valuable insights from this tool.

AmeriHealth Caritas Ohio offers comprehensive coverage that includes preventive care, hospitalization, and specialty services. The plan is designed to cater to various health needs, ensuring members receive necessary treatments. To understand specific coverage details, reviewing the OH AmeriHealth Caritas Facility Data Intake Form is beneficial. This resource outlines what services you can access.

The timely filing limit for AmeriHealth Caritas of Ohio is typically 90 days, much like other Medicaid programs. Submitting your claims within this period is crucial in preventing delays in payment. Review the OH AmeriHealth Caritas Facility Data Intake Form to ensure you understand all relevant policies and requirements associated with timely filings. This will help you stay organized.

Timely filing for Ohio Medicaid requires you to submit claims within a designated timeframe, which is usually 90 days. Understanding this deadline helps prevent claim denials for late submission. For comprehensive details, the OH AmeriHealth Caritas Facility Data Intake Form can provide necessary insights and instructions. Be proactive about your submissions to ensure smooth processing.

To apply for AmeriHealth Caritas PA, you need to visit the official AmeriHealth Caritas website. There, you can find the option for the OH AmeriHealth Caritas Facility Data Intake Form. Once you complete the form, submit it along with any required documents for review. This will help you access a range of health services offered by AmeriHealth.

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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
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