Get the free Community Intervention Services (CIS) Agency Re-enrollment Addendum - ncdhhs
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This document is the re-enrollment addendum for licensed providers seeking to re-enroll as Community Intervention Services (CIS) providers with the North Carolina Medicaid Program, detailing the necessary
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How to fill out community intervention services cis
How to fill out Community Intervention Services (CIS) Agency Re-enrollment Addendum
01
Obtain the Community Intervention Services (CIS) Agency Re-enrollment Addendum form from the appropriate agency website or office.
02
Carefully read the instructions provided at the top of the form.
03
Fill out the agency's name and address in the designated fields.
04
Enter the contact information for the agency's representative, including name, phone number, and email address.
05
Provide the agency's previous enrollment details, including any relevant identification numbers.
06
Complete all necessary sections related to service delivery, including personnel qualifications and experience.
07
Review the form for any required signatures, ensuring that they are signed and dated by the authorized personnel.
08
Submit the completed form to the designated agency office via the preferred submission method, such as email or mail.
09
Keep a copy of the submitted form for your records.
Who needs Community Intervention Services (CIS) Agency Re-enrollment Addendum?
01
Community Intervention Services (CIS) providers wishing to continue their services.
02
Agencies that have gone through any changes such as name, ownership, or service delivery models since the last enrollment.
03
New applicants looking to start providing Community Intervention Services.
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What is Community Intervention Services (CIS) Agency Re-enrollment Addendum?
The Community Intervention Services (CIS) Agency Re-enrollment Addendum is a document required for agencies to update their information and confirm their eligibility to provide community intervention services.
Who is required to file Community Intervention Services (CIS) Agency Re-enrollment Addendum?
Agencies that are currently providing or wish to continue providing Community Intervention Services must file the CIS Agency Re-enrollment Addendum.
How to fill out Community Intervention Services (CIS) Agency Re-enrollment Addendum?
To fill out the CIS Agency Re-enrollment Addendum, an agency must provide updated information regarding their services, staff qualifications, compliance with regulations, and any changes in their operational status.
What is the purpose of Community Intervention Services (CIS) Agency Re-enrollment Addendum?
The purpose of the CIS Agency Re-enrollment Addendum is to ensure that agencies continue to meet the necessary qualifications and standards to offer community intervention services, thereby maintaining the quality and integrity of services provided.
What information must be reported on Community Intervention Services (CIS) Agency Re-enrollment Addendum?
The information that must be reported includes the agency's current operational status, staffing details, service delivery updates, compliance with licensing standards, and any changes in policies or procedures.
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