Get the free Enhanced Primary Care Rates for CY 2013 Self-Attestation Form - dhhr wv

This document serves as a self-attestation form for physicians and Advanced Practice Registered Nurses (APRNs) to qualify for enhanced primary care rates based on eligibility requirements set by the

How to fill out enhanced primary care rates

How to fill out Enhanced Primary Care Rates for CY 2013 Self-Attestation Form

1. Obtain the Enhanced Primary Care Rates for CY 2013 Self-Attestation Form from the relevant health authority's website or office.
2. Carefully read the instruction sheet provided with the form to understand the requirements.
3. Fill out the identification section by providing your name, practice details, and contact information.
4. Complete the attestations section by confirming your understanding of the program and its requirements.
5. Provide information about the patient population you serve, including demographics and total number of patients.
6. Include details on your practice's commitments to providing enhanced primary care services.
7. Review all filled information for accuracy and completeness.
8. Sign and date the form to certify that all information provided is truthful.
9. Submit the completed form to the designated health authority by the specified deadline.

Who needs Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

1. Health care providers who are offering enhanced primary care services to eligible patients across the designated population.
2. Practices looking to receive reimbursement under the Enhanced Primary Care Rates program.
3. Providers participating in care coordination and management initiatives.

For pdfFiller’s FAQs

What is Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

The Enhanced Primary Care Rates for CY 2013 Self-Attestation Form is a document used by healthcare providers to confirm their eligibility for enhanced reimbursement rates for primary care services for the calendar year 2013.

Who is required to file Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

Healthcare providers participating in Medicare or Medicaid who wish to receive enhanced payment rates for specific primary care services are required to submit this form.

How to fill out Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

To fill out the form, providers must provide their basic practice information, attest to their qualifications, and include any required documentation demonstrating their eligibility for enhanced rates.

What is the purpose of Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

The purpose of the form is to ensure that providers meet the criteria set forth for enhanced primary care payments, thereby reinforcing access to quality primary care services for patients.

What information must be reported on Enhanced Primary Care Rates for CY 2013 Self-Attestation Form?

Providers must report their National Provider Identifier (NPI), practice specialty, confirmation of qualifications, and any other relevant data that supports their claim for enhanced payment rates.