Provider Change Form - Rhode Island

Provider Change Form - Rhode Island

Provider Change Form is a legal document that was released by the Rhode Island Department of Human Services - a government authority operating within Rhode Island.

FAQ

Q: What is a Provider Change Form?
A: A Provider Change Form is a document used to request changes to your healthcare provider in Rhode Island.

Q: Why would I need to complete a Provider Change Form?
A: You would need to complete a Provider Change Form if you want to switch your healthcare provider in Rhode Island.

Q: What information is required on the Provider Change Form?
A: The Provider Change Form typically requires information such as your personal details, current healthcare provider information, and the new healthcare provider information.

Q: Are there any fees associated with submitting a Provider Change Form?
A: Fees may vary, depending on your healthcare insurance plan. It is recommended to check with your insurance provider or review your plan documents for information on fees.

Q: Can I change my healthcare provider anytime?
A: In most cases, you can change your healthcare provider during the open enrollment period. However, there may be exceptions for certain qualifying events such as marriage, birth of a child, or loss of coverage.

Q: What should I do after submitting a Provider Change Form?
A: After submitting a Provider Change Form, it is recommended to contact your new healthcare provider to establish a relationship and ensure a smooth transition of care.

Q: Can I cancel a Provider Change Form request?
A: Depending on the specific circumstances, you may be able to cancel a Provider Change Form request. It is important to contact your healthcare insurance company for assistance.

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Form Details:

  • The latest edition currently provided by the Rhode Island Department of Human Services;
  • 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 printable version of the form by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Human Services.

Download Provider Change Form - Rhode Island

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