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Form DMS-673 Provider Address Change Form - Arkansas
What Is Form DMS-673?
This is a legal form that was released by the Arkansas Department of Human Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DMS-673?
A: Form DMS-673 is the Provider Address Change Form in Arkansas.
Q: What is the purpose of Form DMS-673?
A: The purpose of Form DMS-673 is to notify the Arkansas Department of Human Services of a change in provider address.
Q: Who needs to fill out Form DMS-673?
A: The form should be filled out by providers who have changed their address.
Q: Is there a fee to submit Form DMS-673?
A: No, there is no fee to submit Form DMS-673.
Q: What information is required on Form DMS-673?
A: The form requires information such as the provider's name, Medicaid ID or NPI, old address, new address, and effective date of the change.
Q: How should I submit Form DMS-673?
A: You can submit Form DMS-673 by mail or fax to the Arkansas Department of Human Services.
Q: Are there any supporting documents required with Form DMS-673?
A: No, there are no supporting documents required with Form DMS-673.
Q: What is the processing time for Form DMS-673?
A: The processing time for Form DMS-673 may vary, but it is recommended to submit the form as soon as possible.
Q: Who should I contact for questions regarding Form DMS-673?
A: For any questions or concerns about Form DMS-673, you can contact the Arkansas Department of Human Services.
Form Details:
- Released on May 28, 2018;
- The latest edition provided by the Arkansas Department of 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 DMS-673 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Human Services.
