Get the free SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application - scdhhs
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This document provides instructions for applicants enrolling in the Medicaid program, detailing required disclosures regarding ownership and control interests, and includes a form to disclose ownership
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How to fill out scdhhs form 1513 cover
How to fill out SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application
01
Obtain SCDHHS Form 1513 Cover Page from the official SCDHHS website or contact the agency.
02
Fill in the provider name accurately as it appears on official documents.
03
Provide the mailing address for the provider, ensuring it is up-to-date.
04
Enter the Tax Identification Number (TIN) or Social Security Number (SSN) associated with the provider.
05
Indicate the type of provider and selected services offered in the respective sections.
06
Complete the contact information including phone number and email address for communication purposes.
07
Review all filled information carefully for accuracy and completeness.
08
Sign and date the form at the designated section to authorize the application.
09
Submit the completed form along with any additional required documents as specified in the instructions.
Who needs SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
01
Healthcare providers seeking to enroll in the South Carolina Medicaid program.
02
Individuals or organizations providing Medicaid services in South Carolina.
03
New provider applicants or current providers needing to update their enrollment information.
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People Also Ask about
How long does it take to get approved for Medicaid in SC?
0:27 1:59 There are four types of Medicaid. Programs each designed to cover different groups of people let'sMoreThere are four types of Medicaid. Programs each designed to cover different groups of people let's dive into what each one offers. First up we have the traditional Medicaid this one's the original.
How do I change my Medicaid provider in SC?
To make a change, visit the South Carolina Healthy Connections Choices website or call 1-877-552-4642, Monday through Friday, from 8 a.m. to 6 p.m. TTY users should call 1-877-552-4670.
What is the income limit to qualify for Medicaid in SC?
If you need help applying for Healthy Connections (Medicaid), need assistance with your existing health plan or have other questions, please contact Healthy Connections at (888) 549-0820.
What is the maximum income to qualify for Medicaid in SC?
Income Limits Family SizeMonthly Income (Eff. 03/01/2025)Annual Income (Eff. 03/01/2025) 1 $2,609.00 $31,300.00 2 $3,525.00 $42,300.00 3 $4,442.00 $53,300.00 4 $5,359.00 $64,300.005 more rows
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What is SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
SCDHHS Form 1513 Cover Page is a document used to initiate the process of enrolling a healthcare provider in the South Carolina Medicaid program.
Who is required to file SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
Healthcare providers seeking to participate in the South Carolina Medicaid program are required to file SCDHHS Form 1513.
How to fill out SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
To fill out SCDHHS Form 1513, providers must provide accurate information including their contact details, provider type, and any additional information requested on the form.
What is the purpose of SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
The purpose of SCDHHS Form 1513 is to gather necessary information from healthcare providers to facilitate their enrollment in the Medicaid program and ensure compliance with program requirements.
What information must be reported on SCDHHS Form 1513 Cover Page for Medicaid Provider Enrollment Application?
The information required includes the provider's name, address, tax identification number, contact information, and details regarding the type of services they intend to provide.
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