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Get Map 751k

MAP751k (K) 11/13/2012 : : : : : : : : (RVI) :.

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How to fill out the Map 751k online

The Map 751k is an important form used for customer requests related to information changes. This guide provides clear and supportive instructions for filling out the form online, ensuring a smooth and effective submission process.

Follow the steps to complete the Map 751k online successfully.

  1. Press the ‘Get Form’ button to access the form and open it in the required editing interface.
  2. Begin by filling in the case name and case number in their respective fields to identify your request.
  3. For the section labeled 'Request for changes requiring documents,' provide your name, along with any changes you are requesting, such as name, date of birth, or social security number. Be sure to include the reason for each change.
  4. If your request involves changes that do not require documents, such as an address or phone number change, fill out the corresponding fields, indicating both the old and new information.
  5. If applicable, include details regarding changes to immigration status or any other relevant information in the designated sections.
  6. Before submitting, ensure that you or an authorized adult family member has signed and dated the form to validate the request.
  7. After completing the form, you can save your changes, download a copy, print the form, or share it as needed.

Complete your Map 751k form online today!

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Contact support

To update your information with Medicaid, call the HRA Medicaid Helpline at 1-888-692-6116. You should also update your information online so you can get updates about ACCESS HRA. For detailed instructions on how to view your E-Notices see below: Go to ACCESS HRA (nyc.gov/accesshra) and log in or create an account.

Medicaid clients who have lost their EBT cards and have a change of address, should contact the Medicaid helpline to update their contact information at 888-692-6116 to update their address. Clients can also use the MAP-751K form below to make this change and fax it to 917-639-0837.

No, you will have to renew your insurance again. NY State of Health will notify you via email, text, and/or mail when it's time for you to renew each year. When will I need to start renewing Medicaid, Child Health Plus, or Essential Plan insurance for myself and/or my family members?

Medicaid Program Important Phone Numbers New York Medicaid Choice 1–800–505–5678. New York State Department of Health – Medicaid Managed Care.

By mail: NY State of Health, P.O. Box 11774, Albany, NY 12211.

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