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Provider Office Closure Notification Form If you are a contracted Care Oregon Behavioral Health provider and one of your currently contracted office locations is closing and not relocating, or will

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How to fill out provider office closure notification

01

Download the provider office closure notification form from your insurance company's website or request a copy from your insurance representative.

02

Fill out the form with all required information, including your office name, address, contact information, effective date of closure, reason for closure, and any alternate contact information for patients.

03

Submit the completed form to your insurance company according to their specified deadline or procedures.

04

Make sure to notify your patients of the office closure separately and provide them with any necessary information for ongoing care.

Who needs provider office closure notification?

01

Healthcare providers who are closing their office temporarily or permanently.

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What is provider office closure notification?

A provider office closure notification is a formal announcement to inform relevant authorities and stakeholders about the closure of a healthcare provider's office.

Who is required to file provider office closure notification?

Healthcare providers, including doctors, clinics, and medical facilities, are required to file a provider office closure notification when they are permanently closing their office.

How to fill out provider office closure notification?

To fill out a provider office closure notification, one must complete the designated form with necessary details such as the provider's name, address, closure date, and reason for the closure.

What is the purpose of provider office closure notification?

The purpose of the provider office closure notification is to ensure that patients, insurance companies, and regulatory bodies are informed of the closure for continuity of care and administrative purposes.

What information must be reported on provider office closure notification?

Information that must be reported includes the provider's contact details, date of closure, reason for closure, and any instructions for patients regarding their ongoing care.

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