This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the DHS-4049-ENG form?
A: The DHS-4049-ENG form is the Provider Enrollment Application for Billing Intermediaries, Clearinghouses, and EDI Trading Partners in Minnesota Health Care Programs (MHCP)
Q: Who is required to fill out the DHS-4049-ENG form?
A: Billing intermediaries, clearinghouses, and EDI trading partners who want to enroll in Minnesota Health Care Programs (MHCP) are required to fill out this form.
Q: What are Minnesota Health Care Programs (MHCP)?
A: Minnesota Health Care Programs (MHCP) are a collection of health care programs provided by the state of Minnesota to eligible residents.
Q: What is the purpose of the DHS-4049-ENG form?
A: The purpose of the DHS-4049-ENG form is to allow billing intermediaries, clearinghouses, and EDI trading partners to enroll in Minnesota Health Care Programs (MHCP) and participate in electronic data interchange.
Form Details:
Download a fillable version of Form DHS-4049-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.