Get Tenncare Recertify Fax Number Form

This guide provides a clear and supportive approach to help you fill out the Tenncare Recertify Fax Number Form online. By following these detailed steps, you can ensure your application is complete and properly submitted for recertification.

Follow the steps to successfully complete the Tenncare Recertify Fax Number Form.

1. Click the ‘Get Form’ button to access the Tenncare Recertify Fax Number Form. This action will allow you to download and open the form in your preferred editor.
2. Begin by filling in your legal business name as it appears on official documents. This information is crucial for identification purposes.
3. Indicate your doing business as (D/B/A) name, if applicable. If you operate under a different name, make sure to include it here.
4. Enter the practice location, ensuring that you include the physical street address (no P.O. Box). Also, fill out the city, state, zip code, and county fields accurately.
5. Provide your telephone and fax numbers. This contact information is important for communication purposes.
6. If your billing address differs from your practice address, include the legal business name and address where checks and remittance advices should be sent.
7. Complete any additional sections related to the Federal Tax ID, NPI Number, and Taxonomy codes as required. Ensure all fields are filled out accurately to avoid processing delays.
8. Review the application surety statement. This certification assures that all provided information is complete and correct. An original signature must be included from the individual with legal authority.
9. Once you have filled out all required fields, save your changes. You then have the option to download, print, or share the form as necessary.

Begin completing your Tenncare Recertify Fax Number Form online today!