Mental Health Fee-For-Service (Mh Ffs) Contract Hospital Based Provider Agency Administrative Information Form - New Jersey

Mental Health Fee-For-Service (Mh Ffs) Contract Hospital Based Provider Agency Administrative Information Form - New Jersey

Mental Health Fee-For-Service (Mh Ffs) Contract Hospital Based Provider Agency Administrative Information Form is a legal document that was released by the New Jersey Department of Human Services - a government authority operating within New Jersey.

FAQ

Q: What is the Mental Health Fee-For-Service (Mh Ffs) Contract?
A: The Mental Health Fee-For-Service (Mh Ffs) Contract is a contract between a provider agency and the state of New Jersey that allows the agency to provide mental health services on a fee-for-service basis.

Q: What is the purpose of the Hospital Based Provider Agency Administrative Information Form?
A: The purpose of the Hospital Based Provider Agency Administrative Information Form is to collect administrative information from hospital-based provider agencies that have a contract with the state of New Jersey to provide mental health services.

Q: Who is required to fill out the Hospital Based Provider Agency Administrative Information Form?
A: Hospital-based provider agencies that have a contract with the state of New Jersey to provide mental health services are required to fill out the Hospital Based Provider Agency Administrative Information Form.

Q: What information is collected on the Hospital Based Provider Agency Administrative Information Form?
A: The Hospital Based Provider Agency Administrative Information Form collects information such as the agency's name, address, contact information, and billing details.

Q: How is the Hospital Based Provider Agency Administrative Information Form used?
A: The Hospital Based Provider Agency Administrative Information Form is used to ensure that hospital-based provider agencies have the necessary administrative information on file with the state of New Jersey to accurately bill for mental health services provided.

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Form Details:

  • Released on April 1, 2022;
  • The latest edition currently provided by the New Jersey 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the New Jersey Department of Human Services.

Download Mental Health Fee-For-Service (Mh Ffs) Contract Hospital Based Provider Agency Administrative Information Form - New Jersey

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