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This form is used by HPM participating providers to document requests for changes to business records, ensuring the accuracy of the provider record database for claims reimbursement and related purposes.
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How to fill out HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM
01
Obtain the HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM from the official website or by contacting customer service.
02
Fill in the provider's information section, including the provider's name, NPI number, and practice location.
03
Indicate the specific changes being made, such as changes to address, phone number, or billing information.
04
Provide any necessary supporting documents or evidence required for the changes.
05
Review the completed form for accuracy and completeness.
06
Sign and date the form verifying that the information provided is true and accurate.
07
Submit the form via the specified method outlined in the instructions (e.g., fax, email, or postal mail).
Who needs HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
01
Healthcare providers who need to update their records with HEALTHPLUS OF MICHIGAN, including changes in personal information or practice details.
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Use the HAP CareSource provider portal or call Provider Services at 1-833-230-2102.
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What is HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
The HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM is a document used to update or correct information related to healthcare providers within the HealthPlus of Michigan network.
Who is required to file HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
Healthcare providers who need to update their records, such as changes to their office location, contact information, or provider status, are required to file the HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM.
How to fill out HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
To fill out the form, providers should carefully enter their current information, indicate the changes being made, and ensure all required fields are completed before submitting it to the appropriate HealthPlus department.
What is the purpose of HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
The purpose of the form is to maintain accurate and up-to-date records for healthcare providers, ensuring that information is correct for claims processing and provider directories.
What information must be reported on HEALTHPLUS OF MICHIGAN PROVIDER RECORDS CHANGE FORM?
Providers must report information such as their name, National Provider Identifier (NPI), address changes, phone numbers, practice specialties, and any changes in their participation status with HealthPlus of Michigan.
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