PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form 2679
for the current year.
Form 2679 Provider Web Billing User Account Request - Create, Change or Terminate Account - New Hampshire
What Is Form 2679?
This is a legal form that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 2679?
A: Form 2679 is a Provider Web Billing User Account Request form.
Q: What is the purpose of Form 2679?
A: The purpose of Form 2679 is to create, change, or terminate a Provider Web Billing user account.
Q: Who can use Form 2679?
A: Form 2679 can be used by providers in New Hampshire.
Q: What can I do with Form 2679?
A: With Form 2679, you can request to create, change, or terminate a Provider Web Billing user account.
Q: Are there any fees associated with Form 2679?
A: There are no fees associated with Form 2679.
Q: Is Form 2679 specific to New Hampshire?
A: Yes, Form 2679 is specific to providers in New Hampshire.
Q: How long does it take to process Form 2679?
A: Processing time may vary, but you should receive a response within a reasonable time frame.
Q: Is Form 2679 required for all providers in New Hampshire?
A: Form 2679 is not required for all providers, but it may be required for those using the Provider Web Billing system.
Form Details:
- Released on November 1, 2016;
- The latest edition provided by the New Hampshire 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 printable version of Form 2679 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Health and Human Services.
Download Form 2679 Provider Web Billing User Account Request - Create, Change or Terminate Account - New Hampshire
1
2
3
