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CCP OUTOFSTATE AUTHORIZATION REQUEST FORM Fax requests to (844) 8060397. Questions call T19: (866) 2095022 T21: (866) 2021132 To find forms on our website visit http://ccpcares.org/providers/providerresources

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What is ccp out-of-state authorization request?

CCP out-of-state authorization request is a form that allows CCP organizations to operate in a state other than their home state.

Who is required to file ccp out-of-state authorization request?

CCP organizations that wish to operate in a state other than their home state are required to file the ccp out-of-state authorization request.

How to fill out ccp out-of-state authorization request?

The ccp out-of-state authorization request form can usually be filled out online or by mail, and requires information about the CCP organization and the state it wishes to operate in.

What is the purpose of ccp out-of-state authorization request?

The purpose of ccp out-of-state authorization request is to ensure that CCP organizations are authorized to operate in states other than their home state, and to comply with state regulations.

What information must be reported on ccp out-of-state authorization request?

CCP organizations are typically required to report information such as their name, address, purpose of operation in the other state, and contact information.

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