We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • Social Forms
  • South Carolina Social Forms
  • Sc Dhhs Form 1514 2011

Get Sc Dhhs Form 1514 2011-2025

R control interest in the provider and any subcontractor in which the provider has a 5% or more interest. All applicants, except an individual practitioner or group of practitioners as defined in 42 CFR 455.101, must complete this form in order to enroll as a provider in the Medicaid program. The provider must also screen all employees and subcontractors to determine whether they have been excluded from participation in Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP) .

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the SC DHHS Form 1514 online

Filling out the SC DHHS Form 1514 online is an essential process for Medicaid provider enrollment. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently, ensuring compliance with necessary requirements.

Follow the steps to complete the SC DHHS Form 1514 online.

  1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
  2. Identify if you are enrolling as an individual practitioner. If you confirm your status, indicate 'Yes' to be exempt from completing Part 2 of the form. Selecting 'No' will require you to proceed to Part 2.
  3. Provide your full name, Social Security Number (SSN), date of birth, and National Provider Identifier (NPI) if applicable. It’s important to fill out fields marked with an asterisk (*) as they are mandatory.
  4. If applicable, disclose any criminal convictions related to Medicaid, Medicare, or SCHIP. Attach additional pages if necessary to detail the charges, including the city and state of conviction and the date.
  5. Review and confirm that all information is accurate. The certification statement at the end of the form must be signed and dated by the authorized representative to attest that all information is true and complete.
  6. After completing the form, users can choose to save changes, download a copy, print it for their records, or share it as required.

Complete your SC DHHS Form 1514 online now for a smoother Medicaid enrollment process.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Agreements and Forms
Trading Partner Agreement 07/19/13 · Disclosure of Ownership and Control Interest...
Learn more
Budget Modification Form
1514, 100000-41000-70300, General : General Academic Events : Workers ... SC DHHS Contract...
Learn more
Toxicological Profile for 1,4-Dioxane
The ATSDR toxicological profile succinctly characterizes the toxicologic and adverse...
Learn more

Related links form

New York Life Transfer Of Ownership Form 2020 Cif Form Esi Form 28 Flowchart For Login Page

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

The Medicaid program in South Carolina is often referred to as the South Carolina Medicaid program. This program helps low-income residents access necessary medical care. If you are applying for benefits, understanding the SC DHHS Form 1514 will be crucial in your application process.

South Carolina DHHS is the state's leading agency responsible for health and human services, including Medicaid and other supportive programs. They provide resources and support to ensure residents have access to essential health care. The SC DHHS Form 1514 is an important document that supports these efforts.

DHHS stands for Department of Health and Human Services. This agency is vital in administering health programs and services. If you're looking to navigate the services provided, the SC DHHS Form 1514 can offer guidance on how to proceed.

In South Carolina, you typically need to renew your Medicaid coverage annually. It is important to keep your information updated to continue receiving benefits. During the renewal process, the SC DHHS Form 1514 plays a key role in assessing your eligibility.

SC DHHS stands for South Carolina Department of Health and Human Services. This government agency oversees various health programs, including Medicaid. The SC DHHS Form 1514 is crucial for accessing these services, ensuring residents receive the support they need.

To become a Non-Emergency Medical Transportation (NEMT) provider in South Carolina, you will need to fill out and submit the SC DHHS Form 1514. This form includes information about the transportation services you plan to offer and your qualifications. After review, if accepted, you will have the opportunity to provide essential services to Medicaid beneficiaries. Ensuring compliance with all regulations is key for ongoing operations.

To get Medicaid in South Carolina, you must first check your eligibility and then complete the SC DHHS Form 1514. This form requires you to provide personal information, financial details, and documentation. Once submitted, your application will be evaluated, and you will receive a decision regarding your Medicaid benefits. It's important to stay aware of any updates or documentation requests from the Medicaid office.

To receive a Medicaid provider ID, you must first complete the SC DHHS Form 1514 and submit it for approval. Once your application is processed and accepted, you will be assigned a unique provider ID. This ID is essential for billing and interacting with the Medicaid system. Always store your provider ID securely for future reference.

To obtain a National Provider Identifier (NPI) number in South Carolina, you can apply online through the National Plan and Provider Enumeration System (NPPES). Be prepared to provide essential information such as your personal details and the type of services you offer. Securing an NPI number is an important step for all Medicaid providers, including those completing the SC DHHS Form 1514 for enrollment.

Becoming a Medicaid waiver provider involves completing the SC DHHS Form 1514, which is the cornerstone of your application. This form requires detailed information about your services and qualifications. After your application is reviewed and approved, you must adhere to the specific guidelines and standards set for Medicaid waiver providers. Regular training may also be necessary to maintain compliance.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get SC DHHS Form 1514
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232