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Get the free Form AR HO-HPCS 1103 - Arkansas Insurance Department - insurance arkansas

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NAIL NUMBER : COMPANY NAME : CONTACT PERSON: TELEPHONE # : 088-22292 Hanover Insurance Company Lisa Read 517-540-4481 RETURN TO: ARKANSAS INSURANCE DEPARTMENT 1200 WEST THIRD STREET LITTLE ROCK, ARKANSAS
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Form ar ho-hpcs 1103 is a tax form used in the state of Arkansas to report and pay the Health Care Provider Sustainability Fee.
Health care providers operating in Arkansas are required to file form ar ho-hpcs 1103.
To fill out form ar ho-hpcs 1103, you need to provide information such as the name and address of the health care provider, the total number of inpatient days, the total number of outpatient visits, and the total net patient revenue.
The purpose of form ar ho-hpcs 1103 is to calculate and collect the Health Care Provider Sustainability Fee, which helps fund healthcare programs in Arkansas.
Form ar ho-hpcs 1103 requires reporting of information such as the number of inpatient days, the number of outpatient visits, and the net patient revenue for the reporting period.
The deadline to file form ar ho-hpcs 1103 in 2023 is April 15th.
The penalty for the late filing of form ar ho-hpcs 1103 is $100 per day, up to a maximum penalty of $25,000.
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