Medicaid Number definition

Medicaid Number.ย Medicare Number: NPI (Required): Malpractice/Professional Liability Insurance Company Name: (Attach Insurance Face sheet) Policy Number: Expiration Date: Facility Address City State ZIP Types of Privileges: ๐Ÿž Consulting ๐Ÿž Medical Associates ๐Ÿž Active ๐Ÿž Courtesy ๐Ÿž Privs w/o Membership ๐Ÿž Allied Health ๐Ÿž Honorary ๐Ÿž No Privileges ๐Ÿž Clinical ๐Ÿž Provisional/Temp ๐Ÿž I authorize USA to consult with hospital administrators, members of medical staffs, malpractice carriers and other persons to obtain and verify my credentials and qualifications as a provider. I release USA and its employees and agents from any and all liability for their acts performed in good faith and without malice in obtaining and verifying such information and in evaluating my application.
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Medicaid Number.ย Medicare Number: NPI (Required): Malpractice/Professional Liability Insurance Company Name: (Attach Insurance Face sheet) Policy Number: Expiration Date: Facility Address City State ZIP Phone: ( ) Type of Privileges:
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Medicaid Number.ย Medicare Number: NPI (Required): Malpractice/Professional Liability Insurance Company Name: (Attach Insurance Face sheet) Policy Number: Expiration Date: Facility Address City State ZIP Types of Privileges: ๐Ÿž Consulting ๐Ÿž Medical Associates ๐Ÿž Active ๐Ÿž Courtesy ๐Ÿž Privs w/o Membership ๐Ÿž Allied Health ๐Ÿž Honorary ๐Ÿž No Privileges ๐Ÿž Clinical ๐Ÿž Provisional/Temp ๐Ÿž I authorize USA to consult with hospital administrators, members of medical staffs, malpractice carriers and other persons to obtain and verify my credentials and qualifications as a provider. I release USA and its employees and agents from any and all liability for their acts performed in good faith and without malice in obtaining and verifying such information and in evaluating my application. Applicantโ€™s Signature: Date: Supervising Physicianโ€™s Signature: Date: Attn: Network Development, โ–‡โ–‡โ–‡โ–‡ โ–‡โ–‡โ–‡ โ–‡โ–‡โ–‡โ–‡โ–‡ โ–‡โ–‡โ–‡โ–‡, โ–‡โ–‡โ–‡โ–‡โ–‡ โ–‡โ–‡โ–‡, โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡, โ–‡โ–‡โ–‡โ–‡โ–‡ โ–‡โ–‡โ–‡โ–‡โ–‡ Or by email: โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡@โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡.โ–‡โ–‡โ–‡
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Examples of Medicaid Number in a sentence

  • Liability Company Address: Telephone ( ) - Fax ( ) - Contact: DEA License Number: Expiration Date: State License Number: Expiration Date: CLIA Number: Expiration Date: Medicaid Number: Medicare Number: Facility, , acknowledges and agrees that USA, its affiliates and/or agents, has a valid interest in obtaining and verifying information for the purpose of evaluating Facilityโ€™s credentials and qualifications.

  • Mental Health Crisis Center Of Lancaster County (Legibly Print Name of Provider) To be completed by Health Plan only: NPI Number: Effective Date: State Medicaid Number: State Medicare Number: Provider and Contracted Providers shall comply with the applicable provisions of this Schedule A.

  • Attn: Signature Print Name Title Date Federal Tax ID Number: Medicare Number: Medicaid Number: NPI Number: This Kansas Regulatory Requirements Attachment (the โ€œAttachmentโ€) is made part of this Agreement entered into between United Behavioral Health (โ€œUBHโ€) and the health care professional named in this Agreement (โ€œProviderโ€).

  • Yes No Specialty General Oral Surgery Single-Specialty Group Prosthodontics Pediatrics Endodontics Orthodontics Periodontics Medicaid Number (if applicable) Sedation Conscious Ped.

  • In the event OCOA's Medicare or Medicaid Number shall be terminated or suspended as a result of the action or inaction of OCOA or a Physician Employee, and such termination or suspension shall continue for thirty (30) days, unless OCOA shall at that time be acting in good faith (and shall provide reasonable evidence of the action being taken) to reverse such termination or suspension; provided, however, that in no event may such termination or suspension continue for more than ninety (90) days.

  • The child is insured by the following health or accident insurance policies: Name of Company Location of Branch Office Contract or Policy Number or Medicaid Number If the above coverage changes at any time, I/we will immediately inform Teaching-Family Homes of Upper Michigan.

  • Name: Date of Birth: Address: City State Zip Gender: โ–ก Female โ–ก Male โ–ก Non-Binary Telephone Number: Medicaid Number: Medicare Number: โ–ก Part A โ–ก Part B โ–ก Part A & B Additional Insurance Information: โ–ก None Prescription Coverage/Insurance: โ–ก None Relationship to Patient: Address: City State Zip Telephone Number: (Day) (Night) I have received, read, and understand the ElderONE Enrollment Agreement and have been given the opportunity to ask questions.

  • Printed Name: Printed Name: Signature: Signature: Date: Date: and Disability Services January 2007 Individualโ€™s Name Medicaid Number Employer Name Relationship of Employer to Individual Receiving Services: Self Court-Appointed Guardian Parent of a Minor Other Legally Authorized Representative (LAR): I, , the employer, will fulfill all employer responsibilities without the use of a designated representative (DR).

  • IX.4.2. In the event DDD's Medicare or Medicaid Number shall be terminated or suspended as a result of the action or inaction of DDD or a Physician Employee, and such termination or suspension shall continue for thirty (30) days, unless DDD shall at that time be acting in good faith (and shall provide reasonable evidence of the action being taken) to reverse such termination or suspension; provided, however, that in no event may such termination or suspension continue for more than ninety (90) days.

  • In the case of a Medicaid patient, the Hospital District will provide the Medicaid Number, the Add Date, Effective Date and Term Date and such other information as is rea- sonably requested by UTMB.


More Definitions of Medicaid Number

Medicaid Number.ย Address: Phone: Designated Representative: Phone: Relationship: CONSUMER INFORMATION SHEET SeniorCare HHA, INC.
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Medicaid Number.ย Address: City: State: Zip Code: County: Self Guardian: Legal Guardian: 1. 3. 2. 4. (Proof of Guardianship required if age 18+) Phone Number: (primary) Email: Primary Qualifying Diagnosis: Age at Diagnosis: Other Diagnoses: Allergies: Emergency Contacts: ๐ŸžŽ African American or Black ๏ฟฝ๏ฟฝ Hispanic or Latino ๐ŸžŽ Pacific Islander or Asian ๐ŸžŽ American Indian or Alaska Native ๐ŸžŽ White (non-Hispanic) ๐ŸžŽ Multi-Racial ๐ŸžŽ Other: ๐ŸžŽ Intellectual/Developmental ๐ŸžŽ Autism ๐ŸžŽ Currently Residing in a Family Unit ๐ŸžŽ Desire to continue in Family Home Name Birthdate Relationship to Applicant Employed? Disability (if applicable) ๐ŸžŽ FT ๐ŸžŽ PT ๐ŸžŽ FT ๐ŸžŽ PT ๐ŸžŽ FT ๐ŸžŽ PT ๐ŸžŽ FT ๐ŸžŽ PT ๏ฟฝ๏ฟฝ FT ๐ŸžŽ PT ๐ŸžŽ FT ๐ŸžŽ PT Post Office Box 1040 โ— Springfield, Georgia 31329 โ— โ–‡โ–‡โ–‡-โ–‡โ–‡โ–‡-โ–‡โ–‡โ–‡โ–‡ โ— โ–‡โ–‡@โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡โ–‡.โ–‡โ–‡โ–‡ RESPONSIBLE PARTY INITIAL: Name of school applicant attends: Grade: ๐ŸžŽ Self-Contained ๐ŸžŽ Inclusion ๐ŸžŽ General Education ๐ŸžŽ Other
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Related to Medicaid Number

  • Medicaid Regulations means, collectively, (i) all federal statutes (whether set forth in Title XIX of the Social Security Act or elsewhere) affecting the medical assistance program established by Title XIX of the Social Security Act and any statutes succeeding thereto; (ii) all applicable provisions of all federal rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (i) above and all federal administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (i) above; (iii) all state statutes and plans for medical assistance enacted in connection with the statutes and provisions described in clauses (i) and (ii) above; and (iv) all applicable provisions of all rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (iii) above and all state administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (ii) above, in each case as may be amended, supplemented or otherwise modified from time to time.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Medicaid Certification means certification by CMS or a state agency or entity under contract with CMS that health care operations are in compliance with all the conditions of participation set forth in the Medicaid Regulations.

  • Medicaid program means the Kansas program of medical

  • Contract Number means, with respect to any Contract included in the Trust, the number assigned to such Contract by the Servicer, which number is set forth in the related Schedule of Contracts.