Common Contracts
1 similar null contracts
ContractJanuary 24th, 2017
In Home Care Agency, Specialized Living Program, Adult Day ServicesMedicaid Provider Enrollment Application and Agreement This Provider Enrollment Application and Agreement, hereinafter referred to as the “Agreement”, sets forth the conditions and agreements for being enrolled as a provider with the State of Oregon Department of Human Services (DHS), Aging and People with Disabilities Division (APD) or Office of Developmental Disability Services (ODDS) and to receive a provider number. The provider number is required to receive payment for Medicaid services furnished by the provider to Medicaid-eligible individuals in Oregon home and community-based settings. Payments for services are made using federal Medicaid and state funds. Type of action requested New enrollment Provider name change: Renewal or re-enrollment of provider number: Revalidation (only when requested by DHS) provider number:
