CT BHP Re-Registration/Concurrent Review Form 2014 free printable template

CT BHP RE-REGISTRATION/CONCURRENT REVIEW FORM REGISTERED SERVICES Provider EDS/CMAP ID # (Medicaid 9-digit ID) Name of clinician who filled out this form Credentials/Title Facility/Provider Name Telephone

How to fill out CT BHP Re-RegistrationConcurrent Review Form

How to fill out CT BHP Re-Registration/Concurrent Review Form

1. Obtain the CT BHP Re-Registration/Concurrent Review Form from the official website or appropriate office.
2. Fill in your personal information, including your name, contact information, and identification details.
3. Provide details regarding your previous registration status and any changes since the last registration.
4. Complete the sections related to your treatment history and services received.
5. Attach any required documentation, such as proof of prior treatment or relevant medical records.
6. Review the form for accuracy and completeness before submission.
7. Submit the completed form via the designated method (e.g., online or in-person) as specified.

Who needs CT BHP Re-Registration/Concurrent Review Form?

1. Individuals seeking to maintain or renew their registration with the Connecticut Behavioral Health Partnership.
2. Providers who require an update on concurrent reviews for ongoing patient care.
3. Those who have changed their circumstances or treatment plans and need to notify the relevant authorities.

People Also Ask about

What is needed to register an out of state car in CT?

Step 2: Gather required documents before scheduling an appointment Identification - see acceptable forms of ID. Proof of insurance. Completed application for registration and title (Form H-13B). Vehicle Inspection Report (VIR). Payment for fees. Proof of ownership. Mail to:

Can you re register your car online in CT?

If your vehicle registration has expired, here are the instructions to re-register your vehicle. Renew your registration online through DMV's AutoRenew. This online service offers the opportunity to renew some kinds of registrations from the convenience of a computer.

Can you transfer registration online in CT?

Connecticut Titling Services Online Transfer ownership and get tags for your vehicle right from your mobile phone. With eTags' online title transfer and registration, you can get a new Connecticut license plate or transfer a plate you already own.

How do I reinstate my suspended registration in CT?

Pay the $175 reinstatement fee to the DMV. (Additional fees may apply - e.g., IID administration fee $100). You can pay the fee online, by phone at 860-263-5720, or by mail (check or money order made payable to “DMV”). Check your license status before you begin driving.

What documents do I need to re register a car in CT?

Renew your vehicle registration Make an appointment at a DMV office. Provide license plate number or registration document for your expired vehicle. Present your Connecticut driver's license. Complete application for Registration and Certificate of Title (Form H-13B).

How do I change my car registration in CT?

Visit a Connecticut Department of Motor Vehicles office. If you are just transferring your registration then you can visit a hub or limited service office. Make sure to bring along the following documents: Completed registration form H-13B (fill it out at home and bring it with you) Proof of insurance.

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What is CT BHP Re-Registration/Concurrent Review Form?

The CT BHP Re-Registration/Concurrent Review Form is a document used for the re-registration and concurrent review of behavioral health providers in Connecticut's Behavioral Health Partnership.

Who is required to file CT BHP Re-Registration/Concurrent Review Form?

Providers that participate in the Connecticut Behavioral Health Partnership are required to file this form to ensure their services continue to meet the necessary standards for re-registration and concurrent review.

How to fill out CT BHP Re-Registration/Concurrent Review Form?

To fill out the CT BHP Re-Registration/Concurrent Review Form, providers must complete all sections accurately, provide necessary supporting documentation, and submit it to the appropriate state agency by the deadline specified in the form instructions.

What is the purpose of CT BHP Re-Registration/Concurrent Review Form?

The purpose of the CT BHP Re-Registration/Concurrent Review Form is to evaluate and verify that behavioral health providers continue to meet the requirements for participation in the state’s Medicaid program and to facilitate ongoing oversight.

What information must be reported on CT BHP Re-Registration/Concurrent Review Form?

The form requires providers to report their business information, details about the services offered, compliance with regulatory requirements, and any changes in ownership, personnel, or service delivery since the last registration.