Get Maine Aps Form

Filling out the Maine Aps Form is a straightforward process, essential for the deactivation of users, locations, or organizations in the APS CareConnection® system. This guide provides clear, step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to successfully complete the Maine Aps Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the user's first name, last name, and logon ID in the appropriate fields. This information identifies the user being deactivated.
3. Next, provide the name of the agency or hospital the user is associated with. This helps to confirm the correct organization involved in the deactivation process.
4. Specify the date on which the user should be deactivated from APS CareConnection®. Ensure this date aligns with your organizational policy.
5. If you are deactivating a location, National Provider Identifier (NPI), or an organization, fill in the name of the organization or location(s) to be deactivated.
6. Enter the MaineCare NPI numbers that will no longer be in use. This is critical for maintaining accurate records.
7. Indicate the date to deactivate the location, NPI, or organization from APS CareConnection®. Confirm this is accurate and reflects the planned change.
8. Check the applicable boxes to specify whether you are deactivating an organization, location, or NPI. This ensures clarity in your request.
9. Finally, provide the signature of the person authorized to request the removal and their title, along with the date of signature.
10. Once all the information is complete, save your changes, and fax it to (866) 325-4752 to finalize the deactivation process.

Complete the Maine Aps Form online today to ensure timely processing of deactivation requests.