Get Doh Form

This guide provides a comprehensive overview of how to successfully fill out the Doh Form online. By following these steps, you can ensure that your submission is complete and accurate, facilitating a smooth approval process.

Follow the steps to complete the Doh Form online effectively.

1. Click 'Get Form' button to access the Doh Form and open it in your designated online editor.
2. In Section A, select whether you are submitting a new management contract, an amendment, an extension, or a renewal. Ensure you provide the original contract ID and relevant dates if applicable.
3. Indicate the anticipated effective date and contract term in the designated fields. Ensure these dates align with your intended timeline.
4. Specify the MCO Unique Contract or Amendment ID number required for identification purposes on the contract.
5. Confirm whether the main body of the contract includes the necessary management contract standard clauses by checking 'Yes' or 'No,' along with the relevant page number.
6. Check the applicable lines of business that are covered by this contract, such as Medicaid, Medicare, and others, to indicate the areas impacted.
7. Complete the character and competence review section by providing the date of the last review and enclosing any required forms or documentation.
8. In Section B, fill out the MCO name and the management contractor's information, ensuring all contact details, such as phone number and address, are accurate.
9. Provide additional contracting parties or entities if applicable, noting their relationships to the MCO.
10. In Section C, respond to questions regarding the renewal or extension of the management contract, ensuring you check all that apply regarding the goals, quality of care, and reporting.
11. List activities delegated to the contractor if applicable, specifying the scope of delegation regarding management activities and health care services managed.
12. In Section D, identify relevant provisions in the contract related to staffing, performance criteria, and monitoring obligations. Include relevant page numbers and clauses.
13. Detail financial arrangements in Section E, including the payment methodology, financial incentives, administrative costs, and terms of reimbursement.
14. Finally, complete the certification section by filling in your details, signing, and dating the form to attest to the accuracy and compliance of the information submitted.
15. Once all sections are complete and you have reviewed for accuracy, save changes, download a copy for your records, or print the form for submission.

Start filling out the Doh Form online today to ensure timely submission and processing.