Form 2617 Application for Certification and Enrollment of Private Behavioral Health Providers - New Hampshire

What Is Form 2617?

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 2617?
A: Form 2617 is the Application for Certification and Enrollment of Private Behavioral Health Providers in New Hampshire.

Q: Who needs to fill out Form 2617?
A: Private behavioral health providers in New Hampshire who wish to become certified and enrolled providers need to fill out this form.

Q: What is the purpose of Form 2617?
A: The purpose of Form 2617 is to verify the qualifications and credentials of private behavioral health providers in New Hampshire and to enroll them in the state's certification program.

Q: What information do I need to provide on Form 2617?
A: You will need to provide your personal information, professional credentials, details about your practice and services, and any supporting documentation required by the application.

Q: Are there any fees associated with Form 2617?
A: Yes, there is a fee associated with the application process. The exact fees and payment instructions can be found on the application form.

Q: What happens after I submit Form 2617?
A: Once your completed application is submitted, it will be reviewed by the New Hampshire Department of Health and Human Services. If approved, you will be notified of your certification and enrollment status.

Q: How long does it take to process Form 2617?
A: The processing time may vary, but you can expect it to take several weeks to a few months for your application to be processed, reviewed, and approved.

Q: What if my application is denied?
A: If your application is denied, you will be provided with a reason for the denial and given an opportunity to address any deficiencies or submit additional information for reconsideration.

Q: Is certification and enrollment mandatory for private behavioral health providers in New Hampshire?
A: Yes, private behavioral health providers in New Hampshire are required to be certified and enrolled in order to provide services and receive reimbursement from certain state-funded programs.