Form SFN769 Request for Service Authorization for Out-of-State Services - North Dakota

What Is Form SFN769?

This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form SFN769?A: Form SFN769 is a request forservice authorization for out-of-state services in North Dakota.

Q: Who needs to fill out Form SFN769?A: Healthcare providers in North Dakota who need authorization for out-of-state services.

Q: What information is required on Form SFN769?A: Form SFN769 requires information about the healthcare provider, the patient, the requested services, and the reason for the out-of-state treatment.

Q: How long does it take to get approval for out-of-state services?A: The approval process can vary, but it typically takes several weeks to receive a decision.

Q: What if my request for out-of-state services is denied?A: If your request is denied, you have the right to appeal the decision.

Q: Can I submit Form SFN769 electronically?A: Yes, the North Dakota Department of Human Services allows electronic submission of Form SFN769.

Q: Are there any fees associated with Form SFN769?A: There are no fees for submitting Form SFN769.

Q: Who can I contact for more information about Form SFN769?A: You can contact the North Dakota Department of Human Services for more information about Form SFN769.