Form DOH-4486 Change in Payor Filing Status - New York

Form DOH-4486 Change in Payor Filing Status - New York

What Is Form DOH-4486?

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-4486?
A: Form DOH-4486 is the Change in Payor Filing Status form for New York.

Q: What is the purpose of Form DOH-4486?
A: The purpose of this form is to notify the New York Department of Health about a change in payor filing status.

Q: Who needs to fill out Form DOH-4486?
A: Any individual or organization that has experienced a change in payor filing status in New York needs to fill out this form.

Q: What information is required on Form DOH-4486?
A: The form requires information such as the previous payor, effective date of the change, and new payor details.

Q: Is there a deadline for submitting Form DOH-4486?
A: Yes, the form should be submitted to the New York Department of Health within 30 days of the payor filing status change.

Q: Are there any fees associated with submitting Form DOH-4486?
A: There are no fees associated with submitting this form.

Q: What should I do if I have questions or need assistance with Form DOH-4486?
A: If you have any questions or need assistance, you can contact the New York Department of Health for guidance.

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Form Details:

  • Released on May 1, 2012;
  • The latest edition provided by the New York State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form DOH-4486 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.

Download Form DOH-4486 Change in Payor Filing Status - New York

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