Common Contracts
1 similar Provider Enrollment Application and Agreement contracts
Provider Enrollment Application and AgreementProvider Enrollment Application and Agreement • July 18th, 2018
This Provider Enrollment Application and Agreement (Agreement), sets forth the conditions and agreements for being enrolled as a Medicaid Personal Support Worker (Provider) with the State of Oregon Department of Human Services (DHS), Office of Developmental Disabilities Services (ODDS), and to receive a Provider number to receive payment for services furnished by the Provider to approved Medicaid eligible individuals (Recipients) in Oregon. Payments for services are made using federal Medicaid and state funds.
