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AHC CCS Arizona Health Care Cost Containment System VENDOR QUESTIONS NAME OF SOLICITATION: SOLICITATION NUMBER: Question # Broker for NEXT Services for Fee for Service Population RFI YH140008 Vendor
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How to fill out yh14-0008-nemt broker-combined - azahcccs
How to Fill out yh14-0008-nemt broker-combined - azahcccs:
01
Begin by entering the required information at the top of the form, such as the name of the broker and the date.
02
Provide your contact information, including your name, address, phone number, and email.
03
Next, specify the type of broker you are applying for, whether it's an individual or organization.
04
Fill in the necessary details about your organization, including the legal name, Tax ID, and National Provider Identifier (NPI) number.
05
Indicate whether you are opting for enrollment in the Arizona Health Care Cost Containment System (AHCCCS) or any other program.
06
If you have previously submitted an application, provide the Application ID, date of submission, and the name used on the previous application.
07
Include any additional information that may be required, such as affiliations with other organizations or a mailing address different from the main address.
08
Review all the information provided to ensure accuracy and completeness before submitting the form.
Who Needs yh14-0008-nemt broker-combined - azahcccs:
The yh14-0008-nemt broker-combined - azahcccs form is necessary for individuals or organizations that wish to apply as a broker for non-emergency medical transportation (NEMT) services in Arizona. Whether you are a provider looking to join the Arizona Health Care Cost Containment System (AHCCCS) or any other program, this form is essential for establishing your eligibility and fulfilling the necessary requirements. By filling out this form correctly, you can help ensure that you meet the necessary criteria to become a certified NEMT broker in Arizona.
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What is yh14-0008-nemt broker-combined - azahcccs?
This form is a combined report for non-emergency medical transportation (NEMT) brokers in Arizona managed by AHCCCS.
Who is required to file yh14-0008-nemt broker-combined - azahcccs?
All NEMT brokers in Arizona who have a contract with AHCCCS are required to file this form.
How to fill out yh14-0008-nemt broker-combined - azahcccs?
The form must be completed with accurate information regarding NEMT services provided, billing details, and other required data.
What is the purpose of yh14-0008-nemt broker-combined - azahcccs?
The purpose of this form is to track and monitor NEMT services provided to AHCCCS members by brokers to ensure compliance with regulations and quality of services.
What information must be reported on yh14-0008-nemt broker-combined - azahcccs?
Information such as trip details, member information, billing codes, and other relevant data related to NEMT services must be reported on this form.
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