Provider Enrollment Application - Affiliated Practice Hygienist - Arizona

Provider Enrollment Application - Affiliated Practice Hygienist - Arizona

Provider Enrollment Application - Affiliated Practice Hygienist is a legal document that was released by the Arizona Health Care Cost Containment System - a government authority operating within Arizona.

FAQ

Q: What is a Provider Enrollment Application?
A: A Provider Enrollment Application is a form that healthcare providers must complete to enroll in a health insurance program to receive reimbursement for their services.

Q: What is an Affiliated Practice Hygienist?
A: An Affiliated Practice Hygienist is a dental hygienist who is employed by or has a contract with a dental practice to provide dental hygiene services.

Q: How do I apply to become an Affiliated Practice Hygienist in Arizona?
A: To become an Affiliated Practice Hygienist in Arizona, you need to complete and submit the Provider Enrollment Application to the appropriate health insurance program.

Q: What information do I need to include in the Provider Enrollment Application?
A: The Provider Enrollment Application typically requires information about your personal background, education, licensure, and affiliation with a dental practice.

Q: What health insurance programs can I enroll in as an Affiliated Practice Hygienist?
A: As an Affiliated Practice Hygienist, you may be able to enroll in health insurance programs such as Medicaid, Medicare, or private health insurance plans.

Q: How long does it take to process a Provider Enrollment Application?
A: The processing time for a Provider Enrollment Application varies depending on the health insurance program, but it typically takes several weeks to a few months.

Q: What happens after my Provider Enrollment Application is approved?
A: After your Provider Enrollment Application is approved, you will be eligible to provide dental hygiene services and receive reimbursement from the health insurance program for your services.

Q: What should I do if my Provider Enrollment Application is denied?
A: If your Provider Enrollment Application is denied, you can typically appeal the decision and provide additional information or documentation to support your eligibility.

Q: Are there any fees associated with submitting a Provider Enrollment Application?
A: Some health insurance programs may require a fee to be paid when submitting a Provider Enrollment Application. The specific fees and payment process may vary.

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Form Details:

  • Released on May 1, 2017;
  • The latest edition currently provided by the Arizona Health Care Cost Containment System;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arizona Health Care Cost Containment System.

Download Provider Enrollment Application - Affiliated Practice Hygienist - Arizona

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