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Form DOH-4409 Payor / Tpa / Aso Change of Information - New York
What Is Form DOH-4409?
This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DOH-4409?
A: Form DOH-4409 is the Payor/Tpa/Aso Change of Information form.
Q: Who needs to fill out Form DOH-4409?
A: Insurance payors, third-party administrators (TPAs), or administrative services only (ASO) organizations in New York need to fill out this form to update their contact or company information.
Q: What information can be updated with Form DOH-4409?
A: Form DOH-4409 can be used to update payor, TPA, or ASO contact information, changes in ownership, mergers, acquisitions, or changes in corporate structure.
Q: How should I submit Form DOH-4409?
A: Form DOH-4409 should be submitted to the New York State Department of Health using the provided mailing address or fax number.
Q: Are there any fees associated with submitting Form DOH-4409?
A: No, there are no fees associated with submitting Form DOH-4409.
Q: Is Form DOH-4409 mandatory?
A: Yes, insurance payors, TPAs, and ASOs are required to update their information using Form DOH-4409 when there are any changes in their contact or company information.
Form Details:
- Released on May 1, 2012;
- The latest edition provided by the New York State 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 DOH-4409 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
