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 Form SFN615?
A: Form SFN615 is the Medicaid Program Provider Agreement for North Dakota.

Q: What is the purpose of Form SFN615?
A: The purpose of Form SFN615 is to establish a contractual agreement between healthcare providers and the North Dakota Medicaid Program.

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

Q: What information is required on Form SFN615?
A: Form SFN615 requires information such as provider details, services offered, billing information, and agreement terms.

Q: Are there any fees associated with Form SFN615?
A: There are no fees associated with completing Form SFN615.

Q: How long does it take to process Form SFN615?
A: The processing time for Form SFN615 may vary, but typically it takes a few weeks to be reviewed and approved.

Q: What happens after Form SFN615 is approved?
A: After Form SFN615 is approved, the healthcare provider can begin accepting Medicaid patients and billing the program for services provided.

Q: Can a provider terminate their agreement with the North Dakota Medicaid Program?
A: Yes, a provider can terminate their agreement with the North Dakota Medicaid Program by submitting a written notice of termination.

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Form Details:

  • Released on December 1, 2022;
  • 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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