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Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota
What Is Form DHS-3640-ENG?
This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DHS-3640-ENG?A: DHS-3640-ENG refers to the Advance Recipient Notice of Non-covered Service/Item specific to the state of Minnesota.
Q: What is the purpose of DHS-3640-ENG?A: The purpose of DHS-3640-ENG is to notify recipients in Minnesota that a particular service or item they are requesting may not be covered under their health care plan.
Q: Who uses DHS-3640-ENG?A: DHS-3640-ENG is used by health care providers in Minnesota to inform their recipients of potential non-covered services or items.
Q: What information does DHS-3640-ENG contain?A: DHS-3640-ENG contains information about the specific non-covered service or item, the reason why it may not be covered, and any alternative options that may be available.
Form Details:
- Released on January 1, 2013;
- The latest edition provided by the Minnesota Department of Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHS-3640-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.
Download Form DHS-3640-ENG Advance Recipient Notice of Non-covered Service / Item - Minnesota
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