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Form SFN1105 Medication Therapy Management (Mtm) Provider Enrollment Application - North Dakota
What Is Form SFN1105?
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.
FAQ
Q: What is the SFN1105 Medication Therapy Management (MTM) Provider Enrollment Application?
A: SFN1105 is an application form used for enrolling as a Medication Therapy Management (MTM) provider in North Dakota.
Q: Who needs to fill out the SFN1105 Medication Therapy Management Provider Enrollment Application?
A: Healthcare providers who want to offer Medication Therapy Management (MTM) services in North Dakota need to fill out this application.
Q: What is Medication Therapy Management (MTM)?
A: Medication Therapy Management (MTM) refers to a comprehensive approach to managing and optimizing medication use for patients.
Q: What is the purpose of the SFN1105 Medication Therapy Management Provider Enrollment Application?
A: The purpose of this application is to gather information from healthcare providers who wish to become MTM providers in North Dakota.
Q: Are there any fees associated with submitting the SFN1105 Medication Therapy Management Provider Enrollment Application?
A: Yes, there is a fee associated with the application. The current fee amount can be found on the application form.
Q: How long does it take to process the SFN1105 Medication Therapy Management Provider Enrollment Application?
A: The processing time can vary. It is recommended to submit the application well in advance to allow for sufficient processing time.
Q: What supporting documents are required to be submitted with the SFN1105 Medication Therapy Management Provider Enrollment Application?
A: The application may require supporting documents such as proof of professional licensure, liability insurance, and other relevant documentation. The specific requirements are outlined on the application form.
Form Details:
- Released on June 1, 2018;
- The latest edition provided by the North Dakota Department of Health and 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 SFN1105 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.
