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DSHS Form 27-094 Medicaid Provider Disclosure Statement - Washington
What Is DSHS Form 27-094?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 27-094?
A: DSHS Form 27-094 is the Medicaid Provider Disclosure Statement in Washington.
Q: Who needs to complete DSHS Form 27-094?
A: Medicaid providers in Washington need to complete DSHS Form 27-094.
Q: What is the purpose of DSHS Form 27-094?
A: The purpose of DSHS Form 27-094 is to disclose information about the Medicaid provider.
Q: Are there any fees associated with submitting DSHS Form 27-094?
A: There are no fees associated with submitting DSHS Form 27-094.
Q: Is DSHS Form 27-094 mandatory?
A: Yes, DSHS Form 27-094 is mandatory for Medicaid providers in Washington.
Q: What information is required on DSHS Form 27-094?
A: DSHS Form 27-094 requires information about the Medicaid provider's identity, history, and ownership.
Q: How often should DSHS Form 27-094 be submitted?
A: DSHS Form 27-094 should be submitted initially and then updated annually or whenever there are changes to the provider's information.
Form Details:
- Released on February 1, 2017;
- The latest edition provided by the Washington State Department of Social and Health 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 printable version of DSHS Form 27-094 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
Download DSHS Form 27-094 Medicaid Provider Disclosure Statement - Washington
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