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Get Molina Healthcare Hdo Application 2013
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How to fill out the Molina Healthcare HDO Application online
Completing the Molina Healthcare Health Delivery Organization (HDO) Application online requires careful attention to detail. This guide provides clear, step-by-step instructions to ensure that you successfully fill out each section of the application form.
Follow the steps to complete the application accurately.
- Use the 'Get Form' button to access the application form and open it in your preferred editing tool.
- Begin with Section 1: Organization Information. Fill in the legal name, DBA name, Medicare and Medicaid numbers, TIN, NPI, and select the ownership type. Ensure the information matches official records.
- Move to Section 2: Current Insurance Coverage. Provide details about professional and general liability insurance, including the current carrier's name, policy number, and coverage amounts. If your facility is not required to carry insurance, indicate as necessary.
- Proceed to Section 3: Physical Location Information. For each practice location, include the DBA name, Medicare certification status, site-specific numbers, address, and accessibility information. Add any relevant languages spoken and practice limitations.
- In Section 4: Primary Contracted Specialty & Taxonomy, select the relevant specialties and corresponding federal taxonomy codes. Make sure to complete a separate application for each specialty.
- Complete Section 5 on Accreditation/Certification. Indicate if your organization is accredited and provide the date of the last survey. Attach necessary documents as proof.
- Fill Section 6: Credentialing Program. Answer all questions regarding verification processes for licenses and certifications, and disclose any legal actions against the organization.
- Finally, review the Attestation and Release of Information Form. Ensure you sign and date it, confirming the information provided is complete and accurate.
- After completing all sections, save your changes. You can choose to download, print, or share the final application as needed.
Begin filling out the Molina Healthcare HDO Application online to join the network today.
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Timely filing for Molina Healthcare in Nebraska generally means submitting your claims within a specified period after providing services. This is important to ensure that healthcare providers receive proper reimbursement for services rendered. For detailed timelines and requirements, consult the Molina Healthcare HDO Application or your provider agreement.
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