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Request to Move to NC Medicaid Direct (Fee for Service) or LME MCO: Provider Form What is this form for? This form is for you to request for an individual with Medicaid to stay in, or move to, NC

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How to fill out cchn - request to

01

Obtain the CCHN request form.

02

Fill out all required personal information, such as name, address, and contact details.

03

Provide information about the reason for the request and any relevant details.

04

Submit the completed form to the appropriate department or organization.

Who needs cchn - request to?

01

Individuals who require specific information or services related to the CCHN program may need to fill out a CCHN request form.

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What is cchn - request to?

cchn - request is a form used to request approval for cchn.

Who is required to file cchn - request to?

Any individual or organization seeking approval for cchn is required to file the request.

How to fill out cchn - request to?

To fill out the cchn - request, one must provide all necessary information and submit the form according to the instructions.

What is the purpose of cchn - request to?

The purpose of the cchn - request is to seek approval for cchn from the relevant authority.

What information must be reported on cchn - request to?

The cchn - request must include details about the cchn being requested, the reason for the request, and any supporting documentation.

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