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The Minnesota Uniform Practitioner Change form is used by all Minnesota health plans to provide a common format for data collection. Submit your updates online: HealthPartners contracted providers
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How to fill out minnesota uniform practitioner change
How to fill out minnesota uniform practitioner change
01
To fill out the Minnesota Uniform Practitioner Change form, follow these steps:
02
Download the form from the official website of the Minnesota Department of Health.
03
Fill in the top section of the form, providing your personal information including your name, address, phone number, and email.
04
Indicate whether you are making a change to your individual practitioner information or clinic/group information.
05
Provide the details of the practitioner or clinic/group that is changing, including their name, address, phone number, and email.
06
Specify the effective date of the change.
07
Sign and date the form.
08
Submit the completed form to the Minnesota Department of Health via mail or fax, as instructed on the form.
09
Keep a copy of the completed form for your records.
Who needs minnesota uniform practitioner change?
01
The Minnesota Uniform Practitioner Change form is needed by individuals or organizations who are making changes to their practitioner or clinic/group information. This may include healthcare practitioners, medical facilities, clinics, hospitals, or any other healthcare providers in the state of Minnesota.
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What is minnesota uniform practitioner change?
The Minnesota Uniform Practitioner Change is a form used to update practitioner information with the Minnesota Department of Health.
Who is required to file minnesota uniform practitioner change?
All licensed healthcare practitioners in Minnesota are required to file the Uniform Practitioner Change form.
How to fill out minnesota uniform practitioner change?
The form can be filled out online or submitted by mail with the required information about the practitioner.
What is the purpose of minnesota uniform practitioner change?
The purpose of the form is to ensure accurate and up-to-date information on healthcare practitioners in Minnesota.
What information must be reported on minnesota uniform practitioner change?
The form requires information such as practitioner's name, license number, contact information, and any changes in practice.
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