Common Contracts
4 similar Provider Enrollment Agreement contracts
Developmental Disabilities Independent Provider Enrollment Application and AgreementProvider Enrollment Agreement • October 20th, 2016
This Provider Enrollment Application and Agreement (the Agreement) sets forth the conditions and agreements for being enrolled as a Medicaid Independent Provider (non-PSW; hereinafter referred to as Provider) with the Department of Human Services (DHS). Under the terms of this Agreement, the Provider will receive a Provider number, as required in order to receive an authorization for services, submit payment claims, and to receive payment for Community Service Payments. Community Service Program services are provided to persons with intellectual or developmental disabilities (hereinafter referred to as Recipients). Payments for services are made using federal Medicaid or State of Oregon funds or a combination of both state and federal funds.
Developmental Disabilities Independent Provider Enrollment Application and AgreementProvider Enrollment Agreement • October 20th, 2016
This Provider Enrollment Application and Agreement (the Agreement) sets forth the conditions and agreements for being enrolled as a Medicaid Independent Provider (non-PSW; hereinafter referred to as Provider) with the Department of Human Services (DHS). Under the terms of this Agreement, the Provider will receive a Provider number, as required in order to receive an authorization for services, submit payment claims, and to receive payment for Community Service Payments. Community Service Program services are provided to persons with intellectual or developmental disabilities (hereinafter referred to as Recipients). Payments for services are made using federal Medicaid or State of Oregon funds or a combination of both state and federal funds.
Developmental Disabilities Independent Provider Enrollment Application and AgreementProvider Enrollment Agreement • October 20th, 2016
This Provider Enrollment Application and Agreement (the Agreement) sets forth the conditions and agreements for being enrolled as a Medicaid Independent Provider (non-PSW; hereinafter referred to as Provider) with the Department of Human Services (DHS). Under the terms of this Agreement, the Provider will receive a Provider number, as required in order to receive an authorization for services, submit payment claims, and to receive payment for Community Service Payments. Community Service Program services are provided to persons with intellectual or developmental disabilities (hereinafter referred to as Recipients). Payments for services are made using federal Medicaid or State of Oregon funds or a combination of both state and federal funds.
Revised 06/29/2016)Provider Enrollment Agreement • June 29th, 2016
This Provider Enrollment Application and Agreement (the Agreement) sets forth the conditions and agreements for being enrolled as a Medicaid Independent Provider (non-PSW; hereinafter referred to as Provider) with the Department of Human Services (DHS). Under the terms of this Agreement, the Provider will receive a Provider number, as required in order to receive an authorization for services, submit payment claims, and to receive payment for Community Service Payments. Community Service Program services are provided to persons with intellectual or developmental disabilities (hereinafter referred to as Recipients). Payments for services are made using federal Medicaid or State of Oregon funds or a combination of both state and federal funds.
