Get Omhsas Healthchoices Bh Mco Attestation Form And Attachments 2020-2025
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How to fill out the Omhsas Healthchoices Bh Mco Attestation Form And Attachments online
This guide provides a comprehensive overview of how to accurately complete the Omhsas Healthchoices Bh Mco Attestation Form And Attachments online. By following these instructions, users can ensure that they submit a complete and correct enrollment application.
Follow the steps to fill out the Omhsas Healthchoices Bh Mco Attestation Form And Attachments.
- Click ‘Get Form’ button to download the Omhsas Healthchoices Bh Mco Attestation Form And Attachments and open it for editing. Ensure you have a PDF editor ready for this task.
- In the 'Action Requested' section, check the appropriate box that applies to your situation: 'Initial Enrollment' if you are a new provider, or 'Service Location Change' if you are changing locations.
- Enter the name of the enrollee in the designated field, including their date of birth if applicable. Attach any necessary fictitious business name documentation if you operate under a dba name.
- Fill in your Tax Identification Information (TIN). Include your Social Security Number and attach the required document proving it, like a copy of your Social Security card.
- Provide your National Provider Identifier (NPI) number. Make sure to attach the NPPES confirmation letter that verifies your NPI.
- Indicate your business type by checking the appropriate box and attach any necessary corporation paperwork.
- Identify the Behavioral Health Managed Care Organization (BH-MCO) you will be working with and list all counties you are approved to serve.
- Check the types of supplemental services you are applying for and attach the required documentation such as Licenses or Certificates of Compliance.
- Select the appropriate age groups you will serve by checking the relevant boxes.
- Complete all confidentiality information questions, providing detailed explanations if necessary.
- List the physical service address where services will be delivered. Remember, a PO Box is not acceptable.
- Indicate the address where you want notifications sent and the address payments should be sent.
- Fill in the home office information as required.
- Sign and date the application, providing your printed name and contact number. Ensure the signature is original.
- After completing the form, review your entries for accuracy, save changes, and prepare to submit the form online.
Complete your Omhsas Healthchoices Bh Mco Attestation Form And Attachments online today to ensure a smooth enrollment process!
Yes, Children's Special Health is a Medicaid program that helps children with special health care needs. This program ensures families have access to necessary medical care and support services. It emphasizes comprehensive treatment options tailored to children’s unique needs. Utilizing the Omhsas Healthchoices Bh Mco Attestation Form And Attachments can help facilitate access to these critical services.
Fill Omhsas Healthchoices Bh Mco Attestation Form And Attachments
Yes, the BHMCO attestation form must be submitted with the enrollment application, and any required accompanying documentation. Each HealthChoices consumer is assigned a Behavioral Health Managed Care Organization (BH-MCO) based on his or her county of residence. Edit, sign, and share omhsas healthchoices bh mco attestation form and attachments online. BH-MCOs must provide the Confirmation and Attestation forms to providers in their network and require the providers that are providing ABA using BSC-ASD and TSS. The County of Berks is responsible for the provision of the HealthChoices Behavioral Health component (mental health and substance use disorder services) The Department has sole authority for terminating a HealthChoices Member from a HealthChoices BH-MCO, subject to the conditions described below. 2.
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