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PROVIDER APPLICATION CHECKOFF LIST/SUPPLEMENTAL FORM If you participate with Council for Affordable Quality Healthcare (CASH), you do not need to complete the attached application. However, you are

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What is provider application check-off listsupplemental?

Provider application check-off listsupplemental is a supplementary checklist used to verify and cross-check information provided in the main provider application form.

Who is required to file provider application check-off listsupplemental?

All providers who have submitted a main provider application form are required to also submit the provider application check-off listsupplemental.

How to fill out provider application check-off listsupplemental?

Provider application check-off listsupplemental can be filled out by entering the required information accurately and completely, following the instructions provided.

What is the purpose of provider application check-off listsupplemental?

The purpose of provider application check-off listsupplemental is to ensure the accuracy and completeness of information provided in the main provider application form.

What information must be reported on provider application check-off listsupplemental?

Provider application check-off listsupplemental must report information such as licensing details, certifications, qualifications, and any additional documentation required.

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