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Provider Enrollment Attestation for Licensed Mental Health Technician - North Dakota
Provider Enrollment Attestation for Licensed Mental Health Technician is a legal document that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota.
FAQ
Q: What is Provider Enrollment Attestation?
A: Provider Enrollment Attestation is a process by which licensed mental health technicians enroll as providers in North Dakota.
Q: Who can enroll as a provider?
A: Licensed mental health technicians can enroll as providers.
Q: Why do I need to enroll as a provider?
A: Enrolling as a provider allows licensed mental health technicians to provide services and bill for them in North Dakota.
Q: How do I enroll as a provider?
A: To enroll as a provider, licensed mental health technicians need to complete the Provider Enrollment Attestation form.
Q: What documents do I need to include with the Provider Enrollment Attestation form?
A: Licensed mental health technicians need to include a copy of their current professional license and a completed W-9 form with the Provider Enrollment Attestation form.
Q: What happens after I submit the Provider Enrollment Attestation form?
A: After submitting the Provider Enrollment Attestation form, licensed mental health technicians will receive confirmation of their enrollment as a provider in North Dakota.
Q: Can I start providing services and billing before enrolling as a provider?
A: No, licensed mental health technicians must complete the Provider Enrollment Attestation process before they can provide services and bill for them.
Q: Is there a fee for enrolling as a provider?
A: There is no fee for enrolling as a provider.
Q: How long does it take to process the Provider Enrollment Attestation form?
A: The processing time for the Provider Enrollment Attestation form is typically 30 days.
Form Details:
- Released on July 1, 2022;
- The latest edition currently provided by the North Dakota Department of Health and 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 North Dakota Department of Health and Human Services.
