Get the free 471-000-506 Nebraska Medicaid Practitioner Fee Schedule for Dental Services - dhhs ne

REV. JULY 2016 MANUAL LETTER #262016NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICESMEDICAID SERVICES 471000506-Page 1 of 22471000506 Nebraska Medicaid Practitioner Fee Schedule for Dental ServicesPayment

How to fill out 471-000-506 nebraska medicaid practitioner

How to fill out 471-000-506 nebraska medicaid practitioner

1. To fill out the 471-000-506 Nebraska Medicaid Practitioner form, follow these steps: 1. Start by entering your personal information, such as name, address, and contact details, in the designated fields.
2. Provide your Medicaid provider number and NPI (National Provider Identifier) in the appropriate spaces.
3. Indicate the type of practitioner you are by checking the relevant box.
4. Fill in your specialty or area of practice in the specified section.
5. If you are applying for Nebraska Medicaid enrollment, include your enrollment number and expiration date.
6. Document your service locations by listing the facilities or clinics where you practice.
7. Specify whether you are an individual, part of a group practice, or a facility-based practitioner.
8. If you are part of a group practice, provide the group name, address, and group NPI.
9. Mention any Medicaid certification you hold, along with its effective date and expiration date.
10. Complete the applicable sections related to Medicare, TRICARE, and other insurance programs if applicable.
11. Sign and date the form, certifying the accuracy of the provided information.
12. Review the form to ensure all fields are completed correctly and legibly before submitting it to the appropriate Medicaid office.

Who needs 471-000-506 nebraska medicaid practitioner?

1. Any healthcare practitioner who wishes to participate in the Nebraska Medicaid program needs to complete the 471-000-506 Nebraska Medicaid Practitioner form.
2. This includes physicians, nurse practitioners, physician assistants, dentists, therapists, and other eligible healthcare providers.
3. The form is required to apply for enrollment or re-enrollment in the Nebraska Medicaid program and to receive reimbursement for services rendered to Medicaid patients.

For pdfFiller’s FAQs

How can I modify 471-000-506 nebraska medicaid practitioner without leaving Google Drive?

People who need to keep track of documents and fill out forms quickly can connect PDF Filler to their Google Docs account. This means that they can make, edit, and sign documents right from their Google Drive. Make your 471-000-506 nebraska medicaid practitioner into a fillable form that you can manage and sign from any internet-connected device with this add-on.

How can I edit 471-000-506 nebraska medicaid practitioner on a smartphone?

The best way to make changes to documents on a mobile device is to use pdfFiller's apps for iOS and Android. You may get them from the Apple Store and Google Play. Learn more about the apps here. To start editing 471-000-506 nebraska medicaid practitioner, you need to install and log in to the app.

How do I complete 471-000-506 nebraska medicaid practitioner on an Android device?

On an Android device, use the pdfFiller mobile app to finish your 471-000-506 nebraska medicaid practitioner. The program allows you to execute all necessary document management operations, such as adding, editing, and removing text, signing, annotating, and more. You only need a smartphone and an internet connection.