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Form IMM-30 Provider Disenrollment Request - New Jersey
What Is Form IMM-30?
This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is form IMM-30?
A: Form IMM-30 is the Provider Disenrollment Request form.
Q: Who can use form IMM-30?
A: Form IMM-30 can be used by providers in New Jersey.
Q: What is the purpose of form IMM-30?
A: The purpose of form IMM-30 is to request disenrollment from a specific healthcare plan.
Q: Is there a fee to submit form IMM-30?
A: No, there is no fee to submit form IMM-30.
Form Details:
- Released on April 1, 2016;
- The latest edition provided by the New Jersey Department of Health;
- 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 printable version of Form IMM-30 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.
