Get the free 471-000-517 Nebraska Medicaid Practitioner Fee Schedule For Physical Therapy and

REV. JULY 1, 2017, MANUAL LETTER #402017NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICESMEDICAID SERVICES 471000517-Page 1 of 1471000517 Nebraska Medicaid Practitioner Fee Schedule For Physical Therapy

How to fill out 471-000-517 nebraska medicaid practitioner

Who needs to fill out the 471-000-517 Nebraska Medicaid Practitioner form?

1. Medical professionals who wish to apply for Medicaid practitioner status in Nebraska need to fill out the 471-000-517 form. This includes doctors, nurses, therapists, and other healthcare providers.
2. Individuals who are already Medicaid practitioners in another state and want to extend their practice to Nebraska also need to complete this form.
3. New practitioners who have recently graduated or obtained their professional license and want to start accepting Medicaid patients in Nebraska must fill out this form.
4. Existing practitioners who want to update their information or make changes to their Medicaid enrollment status in Nebraska may also need to complete this form.

How to fill out the 471-000-517 Nebraska Medicaid Practitioner form:

1. Start by gathering all the necessary documentation. This may include your professional license, National Provider Identifier (NPI) number, tax identification number, and any other relevant credentials.
2. Fill out the personal information section of the form, which typically includes your name, contact information, social security number, and date of birth.
3. Provide details about your professional qualifications, such as your degree, specialty, years of experience, and any board certifications or affiliations.
4. Indicate whether you have any prior Medicaid or Medicare enrollment in another state or jurisdiction. If applicable, provide the details of your previous enrollment.
5. Specify the type of services you plan to offer to Medicaid patients in Nebraska. This may include outpatient care, inpatient care, surgical procedures, mental health services, or other relevant fields.
6. Include information about your practice location(s), including the address, phone number, and hours of operation.
7. If you are part of a group practice, provide details about the group and indicate whether you will be billing under the group's Medicaid ID or your individual ID.
8. Complete the disclosure section, which includes information about any exclusions, sanctions, or disciplinary actions taken against you by any licensing boards or healthcare programs.
9. Review your completed form for any errors or missing information. Ensure that all the required fields have been filled out accurately.
10. Sign and date the form, certifying the accuracy of the provided information.
11. Make a copy of the completed form for your records.
12. Submit the form either electronically through the Nebraska Medicaid Provider Enrollment portal or by mail to the Nebraska Medicaid office. Follow the provided instructions to ensure proper submission.

By completing the 471-000-517 form, eligible medical professionals can apply for or update their Medicaid practitioner status in Nebraska and provide essential healthcare services to Medicaid beneficiaries.

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What is 471-000-517 nebraska medicaid practitioner?

471-000-517 Nebraska Medicaid Practitioner is a form used by healthcare providers in Nebraska who are enrolled as Medicaid practitioners.

Who is required to file 471-000-517 nebraska medicaid practitioner?

Healthcare providers in Nebraska who are enrolled as Medicaid practitioners are required to file the 471-000-517 form.

How to fill out 471-000-517 nebraska medicaid practitioner?

To fill out the 471-000-517 form, healthcare providers need to enter information about the services provided to Medicaid patients and submit it according to the guidelines provided by the Nebraska Medicaid program.

What is the purpose of 471-000-517 nebraska medicaid practitioner?

The purpose of the 471-000-517 form is to report the services provided by healthcare providers to Medicaid patients in Nebraska.

What information must be reported on 471-000-517 nebraska medicaid practitioner?

The 471-000-517 form requires healthcare providers to report details about the services provided, such as patient demographics, procedures performed, and any medications prescribed.