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Provider Enrollment Checklist for Behavioral Health Outpatient Treatment Provider Type 14: Specialty 000, Entity/Agency/Group This checklist must be completed and submitted with the attachments listed
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What is provider enrollment checklist for?
The provider enrollment checklist is a form that healthcare providers must complete to enroll or revalidate their enrollment in a specific healthcare program or network.
Who is required to file provider enrollment checklist for?
Healthcare providers who wish to enroll or revalidate their enrollment in a specific healthcare program or network are required to file the provider enrollment checklist.
How to fill out provider enrollment checklist for?
To fill out the provider enrollment checklist, healthcare providers need to provide accurate and up-to-date information about their practice, billing, credentials, and compliance with regulatory requirements.
What is the purpose of provider enrollment checklist for?
The purpose of the provider enrollment checklist is to ensure that healthcare providers meet the necessary criteria and requirements to participate in a healthcare program or network.
What information must be reported on provider enrollment checklist for?
The provider enrollment checklist typically requires information such as the provider's identification details, practice location, tax identification number, licensure information, affiliations, and accreditation.
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