Get the free Montana Cancer Control Program Provider Enrollment Application - dphhs mt
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ENROLLED MEDICAL SERVICE PROVIDERS A. General Description An enrolled medical service provider s role is to provide direct clinical screening services to MCCP clients and to complete the MCCP data collection forms. Indian Health Service IHS and compacted tribal reservation clinics are enrolled in the program as a health care facility/clinic* Cancer control specialists answer provider questions about the program and assist with orienting providers to the program* B. Medical Service Provider...
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How to fill out Montana Cancer Control Program Provider Enrollment Application
01
Obtain the Montana Cancer Control Program Provider Enrollment Application from the official website or local health department.
02
Read through the application carefully to understand all requirements and instructions.
03
Fill out the provider information section with accurate details including name, address, and contact information.
04
Provide your professional credentials and licenses, ensuring they are up-to-date.
05
Complete the service information section, specifying the cancer control services you intend to provide.
06
Include any necessary supporting documents as outlined in the application instructions.
07
Review your application for any errors or missing information.
08
Submit the completed application along with any required fees to the designated office.
Who needs Montana Cancer Control Program Provider Enrollment Application?
01
Healthcare providers and organizations that wish to participate in the Montana Cancer Control Program and provide cancer screening and prevention services.
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Every Woman Counts (EWC) Program Live in California. Have no or limited health insurance. Have health insurance with a co-payment or deductible, they can't afford. Not be eligible for Medi-Cal. Have income up to 200 percent of the federal poverty level. Be at least 40 years of age for a clinical exam and a mammogram.
What is the meaning of provider enrollment in Medicaid?
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What is Montana Cancer Control Program Provider Enrollment Application?
The Montana Cancer Control Program Provider Enrollment Application is a formal document that healthcare providers must complete to participate in the Montana Cancer Control Program, which aims to reduce the burden of cancer in the state.
Who is required to file Montana Cancer Control Program Provider Enrollment Application?
Healthcare providers who wish to participate in the Montana Cancer Control Program and provide services related to cancer prevention, screening, and treatment are required to file this application.
How to fill out Montana Cancer Control Program Provider Enrollment Application?
To fill out the Montana Cancer Control Program Provider Enrollment Application, providers should carefully read the application instructions, provide accurate and complete information about their practice, qualifications, and the services they offer, and submit the application along with any required supporting documentation.
What is the purpose of Montana Cancer Control Program Provider Enrollment Application?
The purpose of the application is to ensure that healthcare providers meet the necessary qualifications and standards to deliver cancer control services and to facilitate the enrollment process into the program.
What information must be reported on Montana Cancer Control Program Provider Enrollment Application?
The application must report information such as the provider's name, contact details, type of services offered, professional credentials, and any relevant affiliations or partnerships with other healthcare organizations.
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