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Get Hi Dhs 1139 Instructions 2014-2025
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How to fill out the HI DHS 1139 Instructions online
Filling out the HI DHS 1139 form online is a crucial step for applicants seeking to participate in Hawaii's Medicaid program. This guide provides clear and supportive instructions to help users navigate the form efficiently.
Follow the steps to complete the HI DHS 1139 online.
- Press the ‘Get Form’ button to access the HI DHS 1139 Instructions and open it for editing.
- Read through the introductory section carefully to understand the requirements and make sure you have all necessary documents ready.
- Complete Part A with all requested information legibly. This includes the provider information, such as name and National Provider Identifier number.
- Fill out Section I by providing your business name, specialty, Social Security number, and date of birth accurately.
- Provide your correspondence and service address information in Section II. Ensure that at least one in-state service address is included.
- In Section III, include additional information like license numbers and the issuing agency. Attach any required credentialing documents.
- Sign and date the form in the designated areas to confirm that all information provided is accurate.
- Review all sections for completeness and accuracy. Incomplete forms may delay processing.
- Once satisfied, save changes, then download or print the completed form for your records. Ensure to submit the form via the provided mailing address.
Get started with your application and complete the HI DHS 1139 Instructions online today.
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Speaking with a representative from Medicaid is quite straightforward. You can call their customer service line or visit a local office. For specific inquiries or tailored support, it’s beneficial to have the HI DHS 1139 Instructions at hand, as they outline common questions and concerns, ensuring that your conversation is productive.
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