Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota

Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota

What Is Form DHS-3640-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DHS-3640-ENG?
A: DHS-3640-ENG refers to the Advance Recipient Notice of Non-covered Service/Item specific to the state of Minnesota.

Q: What is the purpose of DHS-3640-ENG?
A: The purpose of DHS-3640-ENG is to notify recipients in Minnesota that a particular service or item they are requesting may not be covered under their health care plan.

Q: Who uses DHS-3640-ENG?
A: DHS-3640-ENG is used by health care providers in Minnesota to inform their recipients of potential non-covered services or items.

Q: What information does DHS-3640-ENG contain?
A: DHS-3640-ENG contains information about the specific non-covered service or item, the reason why it may not be covered, and any alternative options that may be available.

ADVERTISEMENT

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the Minnesota Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHS-3640-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

Download Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota

4.8 of 5 (71 votes)
  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service/Item - Minnesota

    1

  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service/Item - Minnesota, Page 2

    2

  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service/Item - Minnesota, Page 3

    3

  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota, Page 1
  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota, Page 2
  • Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota, Page 3
Prev 1 2 3 Next
ADVERTISEMENT

Related Documents