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Clear Form *DHS4074ENG* DHS4074ENG 612 Minnesota Health Care Programs (MCP) MA Home Care Technical Change Request Complete and fax this form to 6514317447 to request a technical change to an existing

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1. Individuals who are applying for or renewing their enrollment in the Minnesota Health Care Programs (MHCP) may need to fill out the dhs-4074-eng - kepro mhcp form. This form is used to gather important information about an individual's medical history, insurance coverage, and eligibility for various healthcare assistance programs.
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What is dhs-4074-eng - kepro mhcp?

DHS-4074-ENG - KEPRO MHCP is a form used to report information related to Medical Assistance (MA) managed care program.

Who is required to file dhs-4074-eng - kepro mhcp?

Healthcare providers participating in the MA managed care program are required to file DHS-4074-ENG - KEPRO MHCP.

How to fill out dhs-4074-eng - kepro mhcp?

The form can be filled out electronically or manually, following the instructions provided by the Minnesota Department of Human Services.

What is the purpose of dhs-4074-eng - kepro mhcp?

The purpose of DHS-4074-ENG - KEPRO MHCP is to collect and report information on services provided to MA members.

What information must be reported on dhs-4074-eng - kepro mhcp?

Information such as member demographics, service details, provider information, and billing information must be reported on DHS-4074-ENG - KEPRO MHCP.