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Form ODM03623 Ohio Medicaid Provider Agreement for Long Term Care Facilities - Ohio
What Is Form ODM03623?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is ODM03623?
A: ODM03623 is the Ohio Medicaid Provider Agreement for Long TermCare Facilities in Ohio.
Q: What is the purpose of ODM03623?
A: The purpose of ODM03623 is to establish a contractual agreement between Ohio Medicaid and long term care facilities in Ohio.
Q: Who needs to complete ODM03623?
A: Long term care facilities in Ohio that wish to participate in the Ohio Medicaid program need to complete ODM03623.
Q: What information is required in ODM03623?
A: ODM03623 requires information such as the facility's name, address, provider number, contact information, and signatures from authorized representatives.
Q: Are there any fees associated with ODM03623?
A: There are no fees associated with completing ODM03623. It is part of the application process for long term care facilities to participate in the Ohio Medicaid program.
Form Details:
- Released on April 1, 2020;
- The latest edition provided by the Ohio Department of Medicaid;
- 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 ODM03623 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
Download Form ODM03623 Ohio Medicaid Provider Agreement for Long Term Care Facilities - Ohio
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