Form DOH-4409 Payor / Tpa / Aso Change of Information - New York

What Is Form DOH-4409?

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DOH-4409?A: Form DOH-4409 is the Payor/Tpa/Aso Change of Information form.

Q: Who needs to fill out Form DOH-4409?A: Insurance payors, third-party administrators (TPAs), or administrative services only (ASO) organizations in New York need to fill out this form to update their contact or company information.

Q: What information can be updated with Form DOH-4409?A: Form DOH-4409 can be used to update payor, TPA, or ASO contact information, changes in ownership, mergers, acquisitions, or changes in corporate structure.

Q: How should I submit Form DOH-4409?A: Form DOH-4409 should be submitted to the New York State Department of Health using the provided mailing address or fax number.

Q: Are there any fees associated with submitting Form DOH-4409?A: No, there are no fees associated with submitting Form DOH-4409.

Q: Is Form DOH-4409 mandatory?A: Yes, insurance payors, TPAs, and ASOs are required to update their information using Form DOH-4409 when there are any changes in their contact or company information.