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State of WyomingCCL300 10/21Department of Family Serviceability VISIT Facility Name: B.E.A.S.T. Foundational: 07/02/2020Time: 11:15Provider: Certificate #: 016871Phone: 3076316320Address: 2900 SunflowerCity:
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Step 1: Gather all necessary documents and information. This may include tax identification number, provider identification number, and any supporting documentation.
02
Step 2: Visit the website or contact the relevant authority to access the application form. The form may be available for download or online submission.
03
Step 3: Fill out the application form carefully, providing accurate and complete information. Follow any instructions provided on the form or accompanying guidelines.
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Step 4: Attach any required supporting documentation, such as proof of qualifications, licenses, or certifications.
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Step 5: Review the completed form and attached documents to ensure everything is in order. Make any necessary corrections or additions.
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Step 6: Submit the completed application form and supporting documents as per the instructions provided. This may involve mailing the form or submitting it online.
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Step 7: Wait for confirmation of receipt and further instructions from the relevant authority. It may take some time for the application to be processed.
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Step 8: Follow up with the relevant authority if you have not received any communication after a reasonable period of time.
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Step 9: Once approved, ensure that the certificate is displayed or kept in a safe place as required by the authority.

Who needs 1115 provider certificate 016871?

01
1115 provider certificate 016871 may be needed by healthcare providers or organizations that participate in specific waiver programs or initiatives. These programs may require certification to ensure compliance with specific regulations, standards, or eligibility criteria. It is advisable to consult the relevant authority or program guidelines to determine if you need this certificate.
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The 1115 provider certificate 016871 is a certification form required for specific healthcare providers to participate in state Medicaid programs under the 1115 waiver.
Healthcare providers who wish to participate in Medicaid services under the 1115 waiver are required to file 1115 provider certificate 016871.
To fill out the 1115 provider certificate 016871, providers must complete all requested information accurately, including provider details, services rendered, and compliance information, and submit the form to their respective state Medicaid agency.
The purpose of the 1115 provider certificate 016871 is to verify that healthcare providers comply with the requirements set forth under the 1115 Medicaid waiver, ensuring eligibility for Medicaid reimbursement.
The information that must be reported on the 1115 provider certificate 016871 includes provider identification details, services offered, compliance with Medicaid standards, and any relevant financial information.
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