Get Buckeye Health Plan Waiver Provider Instructions & Application
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How to fill out the Buckeye Health Plan Waiver Provider Instructions & Application online
Completing the Buckeye Health Plan Waiver Provider Instructions & Application online is an essential step in becoming a MyCare Home and Community-Based Service Provider. This guide will walk you through each section of the application, ensuring a clear understanding of the requirements and information needed for submission.
Follow the steps to complete your application successfully.
- Press the ‘Get Form’ button to access the Buckeye Health Plan Waiver Provider Instructions & Application form and open it in your preferred editor.
- Begin by entering the date in the designated field at the top of the form. This ensures the application is current.
- Fill in your last name and first name as they appear on your identification documents. Include the date of birth as well.
- Input your agency name, if applicable, in the corresponding section.
- Indicate whether you submit claims and receive payments from Morning Star of Ohio by checking the appropriate box.
- Enter your Tax ID number and Social Security number in the specified fields.
- If you have a National Provider Identifier (NPI) number, include it in the designated field.
- Provide your Ohio Medicaid Provider number if you possess one.
- Fill in your primary office street address, including suite number, city, state, and ZIP code.
- Include your primary office phone and fax numbers, as well as your primary office email address.
- Select your provider type by checking either 'independent' or 'agency'.
- Indicate your certifying agency by checking the appropriate box, and enter the date of certification.
- Check the Home and Community-Based Services that you are certified to provide. Be sure to specify only the services for which you hold certification.
- List the counties where you intend to provide services for Buckeye members by checking the applicable boxes.
- Once all fields are accurately filled, review your entries for completeness and accuracy. Save any changes made to the form.
- You may now download, print, or share the completed form as needed for submission.
Start completing the Buckeye Health Plan Waiver Provider Instructions & Application online today to begin your journey as a provider!
MyCare Ohio is a managed care program that integrates Medicaid and Medicare services for individuals with complex needs. It aims to provide coordinated care for those enrolled, ensuring comprehensive support for their health and well-being. For a better understanding of the application process, access the 'Buckeye Health Plan Waiver Provider Instructions & Application,' which can guide you on how to access these services effectively.