Get Home State Health

Filling out the Home State Health form is essential for providers seeking increased payment for primary care services. This guide offers clear instructions to help you navigate the process efficiently and ensure your submission is complete.

Follow the steps to successfully complete the Home State Health form.

1. Press the ‘Get Form’ button to retrieve the form and have it ready for use.
2. Begin by entering your name and address as prompted in the designated fields. Ensure that your information is accurate to avoid processing delays.
3. Provide your city, state, and zip code in the respective fields. This information is vital for identification and correspondence.
4. Review the eligibility criteria outlined in the document to confirm that you qualify for the increased payment. If applicable, prepare your Board Certification documents.
5. Complete the Certification and Attestation for Primary Rate Increase form, providing all required details. If you are not Board Certified, ensure you indicate the percentage of primary care services you billed in 2012.
6. Finalize your submission by determining whether to return the form by mail, email, or fax, as listed in the provided instructions.
7. After you have filled out the form, save your changes. You may also want to download or print the form for your records before sending it.
8. Submit the form as directed and keep a copy for your files.

Complete your Home State Health form online to ensure timely processing of your application.