Get What Do You Need To Recertify Tenncare Form

Completing the What Do You Need To Recertify Tenncare Form online is an essential step for providers seeking to maintain their participation in the Tennessee TennCare/Medicaid Program. This guide will provide clear, step-by-step instructions to ensure your form is filled out accurately and submitted efficiently.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your selected document editor.
2. Fill in the legal business name as it appears on your official documents. This is the name under which you are registered to operate.
3. Provide the doing business as (DBA) name if it differs from the legal business name.
4. Input your practice location, ensuring that no P.O. Box is used. Include the complete address.
5. If applicable, include the pay-to information that matches the W-9 form, specifying any differences in addresses.
6. Indicate the type of enrollment by checking the relevant boxes for new enrollment, change of ownership, recertification, among others.
7. Complete all requested information, including the Federal Tax Identification Number (EIN) and the National Provider Identifier (NPI).
8. Submit required documentation, such as copies of licenses and the CMS Medicare approval letter, ensuring all is included before submission.
9. Review the form for completeness, ensuring no fields are left blank. Complete the assurance statement with the original signature of the authorized person.
10. Save your changes periodically and ensure that you download a copy of the completed form before submission. You may also print or share the form as needed.

Take the time to complete your forms accurately online to ensure a smooth recertification process.