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Get Group Membership Authorization Form

Medicaid Provider ID: or, Application Tracking Number (ATN)Group Membership Authorization Providers who will be submitting Medicaid claims under a group number must indicate the groups Medicaid provider.

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  1. Open the template in the feature-rich online editing tool by clicking Get form.
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  4. Go to the e-signature solution to e-sign the document.
  5. Insert the relevant date.
  6. Read through the entire document to be sure that you have not skipped anything important.
  7. Press Done and download your new document.

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Florida medicaid group membership FAQ

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