Medicaid Number definition

Medicaid Number. Medicare Number: NPI (Required): Malpractice/Professional Liability Insurance Company Name: (Attach Insurance Face sheet) Policy Number: Expiration Date: HOSPITAL/SURGICENTER STAFF PRIVILEGES (Attach additional Staff Privileges) Facility Address City State ZIP Types of Privileges: 🞏 Consulting 🞏 Medical Associates 🞏 Active 🞏 Courtesy 🞏 Privs w/o Membership 🞏 Allied Health 🞏 Honorary 🞏 No Privileges 🞏 Clinical 🞏 Provisional/Temp 🞏 CONSENT/REPRESENTATIONS AND WARRANTIES 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. Medicare Number: NPI (Required): Malpractice/Professional Liability Insurance Company Name: (Attach Insurance Face sheet) Policy Number: Expiration Date: HOSPITAL/SURGICENTER STAFF PRIVILEGES (Attach additional Staff Privileges) Facility Address City State ZIP Phone: ( ) Type of Privileges:
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Medicaid Number. Address: Phone: Next of Kin/ Relationship (Address/ Phone): Emergency Contact / Relationship (Address/ Phone): Designated Representative: Phone: Relationship: CONSUMER INFORMATION SHEET SeniorCare HHA, INC. DIVISION OF RESPONSABILITIES CONTRACT This agreement is made and entered into as of (effective date) between ,(consumer) and SeniorCare HHA, Inc. Both parties agree as follows:
Sample 1

Examples of Medicaid Number in a sentence

  • NAME OF PROVIDER Attn: Signature Print Name Title Date Federal Tax ID Number: Medicare Number: Medicaid Number: NPI Number: UNITED BEHAVIORAL HEALTH PROVIDER AGREEMENT Kansas Regulatory Requirements Attachment This Kansas Regulatory Requirements Attachment (the “Attachment”) is made part of this Agreement entered into between United Behavioral Health (“UBH”) and the health care professional named in this Agreement (“Provider”).

  • 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.

  • Yes or No Medicaid Number: I HEREBY AUTHORIZE PAYMENT OF MEDICAID BENEFITS TO AUBURN CITY SCHOOLS DENTAL CLINIC.

  • Yes No Provider Name* NPI Number (Individual Type 1)* Provider Email Address Washington State License Number* Medicaid Number (if applicable) Sedation Conscious Ped.

  • Languages Spoken Fluently: Last First MI - -  Owner  Partner  Associate Medicaid Number: _ / / _ _  Male  Female  YES (Submit copy)  NO (Complete statement below) IF PENDING COMPLETE: I Dr. _ will not write prescriptions until I have received my current Federal DEA.

  • Date: Resident’s Signature or Mark or Designated Representative: Medicaid Number: Signature of Witness: Printed Name of Witness: Fishkill Center for Rehabilitation and Nursing Photographing, Videotaping, or Other Recordings Consent and Release Form Name of resident D.O.B Unit A.

  • Tax Identification Number: State Medicaid Number: CCHN: Carolina Complete Health Network, Inc.

  • Provider’s Medicaid Number issued for Intensive In-Community Therapy /Behavioral Assistance is If Provider’s Medicaid application is in process, please provide the date that application was submitted: Provider understands that it is Provider’s responsibility to clarify the Medicaid eligibility of the person referred for service before providing any service.

  • Xxxxxxxxxxx Title: Vice President, Network Development & (Legibly Print Name of Provider) Authorized Signature: Print Name: Title: Contracting Signature Date: ECM #: Signature Date: Tax Identification Number: To be completed by Health Plan only: Effective Date: State Medicaid Number: National Provider Identifier: PARTICIPATING PROVIDER AGREEMENT SCHEDULE A CONTRACTED PROVIDER-SPECIFIC PROVISIONS Provider and Contracted Providers shall comply with the applicable provisions of this Schedule A.

  • State Medicaid Number: CCHN: Carolina Complete Health Network, Inc.

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 the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicaid Certification means a certification by a state agency or other entity responsible for certifying Medicaid providers and suppliers that a health care provider or supplier is in compliance with all the conditions of participation set forth in the Medicaid Regulations.

  • Medicaid program means the medical assistance

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Medicare Regulations means, collectively, all Federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting the health insurance program for the aged and disabled established by Title XVIII of the Social Security Act and any statutes succeeding thereto, together with all applicable provisions of all rules, regulations, manuals and orders and administrative, reimbursement and other guidelines having the force of law of all Governmental Authorities (including Health and Human Services (“HHS”), CMS, the Office of the Inspector General for HHS, or any Person succeeding to the functions of any of the foregoing) promulgated pursuant to or in connection with any of the foregoing having the force of law, as each may be amended, supplemented or otherwise modified from time to time.

  • Uniform Network Code means the uniform network code as defined in Standard Special Condition A11(6) of National Grid’s transporters licence, as such code may be amended from time to time in accordance with the terms thereof.

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Abortion-inducing drug means a drug, medicine, mixture, or preparation, when it is prescribed or administered with the intent to terminate the pregnancy of a woman known to be pregnant.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Health care organization ’ means any person or en-

  • Enrollee means any person entitled to health care services from a carrier.

  • Child abuse means any of the following acts committed in an educational setting by an employee or volunteer against a child:

  • Health care facility or "facility" means hospices licensed

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Newborn means a baby less than nine days old.