Form SFN615 Medicaid Program Provider Agreement - North Dakota

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Form SFN615 Medicaid Program Provider Agreement - North Dakota

What Is Form SFN615?

This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the SFN615 Medicaid Program Provider Agreement?
A: The SFN615 Medicaid Program Provider Agreement is a form used in North Dakota for healthcare providers to enter into an agreement with the Medicaid program.

Q: Who needs to complete the SFN615 Medicaid Program Provider Agreement?
A: Healthcare providers who wish to participate in the Medicaid program in North Dakota need to complete the SFN615 Medicaid Program Provider Agreement.

Q: What information is required on the SFN615 Medicaid Program Provider Agreement?
A: The SFN615 Medicaid Program Provider Agreement requires information such as the provider's name, contact information, services offered, and agreement to abide by Medicaid program rules and regulations.

Q: Is there a fee to submit the SFN615 Medicaid Program Provider Agreement?
A: No, there is no fee to submit the SFN615 Medicaid Program Provider Agreement.

Q: Can providers terminate their agreement with the Medicaid program?
A: Yes, providers can terminate their agreement with the Medicaid program by providing written notice to the Medicaid program office.

Q: What happens after submitting the SFN615 Medicaid Program Provider Agreement?
A: After submitting the SFN615 Medicaid Program Provider Agreement, the provider's application will be reviewed, and if approved, they will be enrolled as a Medicaid provider.

Q: How long does it take to get approved as a Medicaid provider after submitting the SFN615 Medicaid Program Provider Agreement?
A: The timeframe for approval as a Medicaid provider after submitting the SFN615 Medicaid Program Provider Agreement can vary, but it typically takes a few weeks to process the application.

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Form Details:

  • Released on September 1, 2021;
  • The latest edition provided by the North Dakota 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 fillable version of Form SFN615 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health and Human Services.

Download Form SFN615 Medicaid Program Provider Agreement - North Dakota

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