WI WPS Health Insurance Facility Data Sheet 2016 free printable template
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Facility Data Sheet
WPS Health Plan, Inc. Use this form to notify Arise Health Plan and WPS Health Insurance of any changes, additions,
or terminations to facilities within your organization. Questions?
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How to fill out WI WPS Health Insurance Facility Data
How to fill out WI WPS Health Insurance Facility Data Sheet
01
Gather necessary information about your health facility.
02
Ensure you have accurate contact details ready, including address, phone number, and email.
03
Fill out the facility's legal name as registered.
04
Provide the facility's tax identification number (TIN).
05
Indicate the types of services offered at your facility.
06
Complete the sections regarding operational hours and staff qualifications.
07
Review the information for accuracy before submission.
08
Submit the completed form as per the provided instructions.
Who needs WI WPS Health Insurance Facility Data Sheet?
01
Health facilities applying for WPS health insurance participation.
02
Providers seeking reimbursement for services rendered under WPS health insurance.
03
Facilities looking to establish or maintain a contractual relationship with WPS.
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What is WI WPS Health Insurance Facility Data Sheet?
The WI WPS Health Insurance Facility Data Sheet is a document used to report healthcare facility data for the purpose of health insurance claims processing and reimbursement in Wisconsin.
Who is required to file WI WPS Health Insurance Facility Data Sheet?
Healthcare facilities that participate in the WPS Health Insurance network and are seeking reimbursement for services rendered are required to file the WI WPS Health Insurance Facility Data Sheet.
How to fill out WI WPS Health Insurance Facility Data Sheet?
To fill out the WI WPS Health Insurance Facility Data Sheet, providers must complete all required sections including facility identification details, service types, and relevant financial information, ensuring accuracy and compliance with WPS guidelines.
What is the purpose of WI WPS Health Insurance Facility Data Sheet?
The purpose of the WI WPS Health Insurance Facility Data Sheet is to collect standardized information from healthcare facilities to streamline the claims process, facilitate accurate reimbursements, and maintain data for health insurance oversight.
What information must be reported on WI WPS Health Insurance Facility Data Sheet?
The information that must be reported on the WI WPS Health Insurance Facility Data Sheet includes facility name, address, type of services provided, licensing information, and financial data related to the services rendered.
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