This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form SFN769?
A: Form SFN769 is a request forservice authorization for out-of-state services in North Dakota.
Q: Who needs to fill out Form SFN769?
A: Healthcare providers in North Dakota who need authorization for out-of-state services.
Q: What information is required on Form SFN769?
A: Form SFN769 requires information about the healthcare provider, the patient, the requested services, and the reason for the out-of-state treatment.
Q: How long does it take to get approval for out-of-state services?
A: The approval process can vary, but it typically takes several weeks to receive a decision.
Q: What if my request for out-of-state services is denied?
A: If your request is denied, you have the right to appeal the decision.
Q: Can I submit Form SFN769 electronically?
A: Yes, the North Dakota Department of Human Services allows electronic submission of Form SFN769.
Q: Are there any fees associated with Form SFN769?
A: There are no fees for submitting Form SFN769.
Q: Who can I contact for more information about Form SFN769?
A: You can contact the North Dakota Department of Human Services for more information about Form SFN769.
Form Details:
Download a fillable version of Form SFN769 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.