Get the free Attachment G.1.A - (Provider Listing CCN-S).xls - dhh louisiana

Attachment.1.aCCNSNetworkListing UnitedHealthcareCommunityPlan CNAME: UnitedHealthcareCommunityPlan PractitionerName BusinessLocationAddress Provider/PracticeName AAudreyStanleyWillisKnightonMedCtr

How to fill out attachment g1a - provider

How to fill out attachment g1a - provider?

1. Begin by filling out the first section of the form, which includes your personal information such as your name, address, and contact details.
2. Next, indicate the type of provider you are by checking the appropriate box. This may include options like an individual provider, a group practice, or an organization.
3. If you are an individual provider, provide details about your professional qualifications, including your license number and any certifications you hold.
4. For group practices or organizations, provide information about the group's name, address, and a contact person if applicable.
5. The next section of the form requires information about your practice, such as the types of services you offer and the languages spoken by your staff.
6. If you participate in any insurance plans, indicate which ones by checking the relevant boxes. You should also provide your National Provider Identifier (NPI) number, which is required for insurance billing.
7. Lastly, sign and date the form to certify that the information provided is accurate and complete.

Who needs attachment g1a - provider?

1. Healthcare providers who are applying to join a network or are updating their information may need to fill out attachment g1a - provider.
2. Providers who are seeking to become credentialed with insurance companies will also need to complete this form.
3. Anyone who is starting a new practice or making changes to their existing practice may be required to submit attachment g1a - provider as part of the application or renewal process.

For pdfFiller’s FAQs

What is attachment g1a - provider?

Attachment g1a - provider is a form used to report information about the provider of services.

Who is required to file attachment g1a - provider?

Health care institutions and providers of services are required to file attachment g1a - provider.

How to fill out attachment g1a - provider?

Attachment g1a - provider must be filled out by providing all the requested information accurately.

What is the purpose of attachment g1a - provider?

The purpose of attachment g1a - provider is to report the provider of services for tax and regulatory compliance.

What information must be reported on attachment g1a - provider?

Information such as the provider's name, address, identification number, and the type of services provided must be reported on attachment g1a - provider.

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