Get Primary Care Rate Increase Attestation - Form #490302 - Emedny - Emedny

Navigating the Primary Care Rate Increase Attestation can seem daunting, but understanding its components is essential for successful submission. This guide provides step-by-step instructions to help you fill out the form confidently.

Follow the steps to complete your attestation accurately.

1. Press the ‘Get Form’ button to access the Primary Care Rate Increase Attestation - Form #490302 - EMedNY.
2. Enter your name in the designated space, ensuring that your name is clearly printed or typed. Include the effective date for your practice, which must fall between January 1, 2013, and December 31, 2014.
3. Either complete Section B or Section C to verify your qualifications for the Primary Care Rate Increase. If you choose Section B, check the appropriate box indicating your Board Certification in Family Medicine, General Internal Medicine, or Pediatric Medicine.
4. If you opt for Section C, confirm that at least 60 percent of the Medicaid codes paid to you reflect evaluation and management services or vaccine administration services in the past calendar year.
5. If you are supervising Nurse Practitioners or Nurse Midwives, complete Section D, providing their names. Ensure their NPI, signatures, and effective dates are included for each individual listed.
6. Review all entered information carefully before signing the form. By signing, you attest that you and those you supervise meet the qualifications for the Primary Care Rate Increase.
7. Once you have completed the form, save any changes, and proceed to download or print the document if needed. Ensure that you mail your attestation to the specified address for processing.

Complete your Primary Care Rate Increase Attestation online today to ensure you receive the appropriate reimbursement for your services.