Form DOH-5247 Medicaid Authorized Representative Designation / Change Request - New York

What Is Form DOH-5247?

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-5247?A: Form DOH-5247 is the Medicaid Authorized Representative Designation/Change Request form used in New York.

Q: What is the purpose of Form DOH-5247?A: The purpose of Form DOH-5247 is to designate or change the authorized representative for Medicaid beneficiaries in New York.

Q: Who can use Form DOH-5247?A: Medicaid beneficiaries in New York can use Form DOH-5247 to designate or change their authorized representative.

Q: How do I fill out Form DOH-5247?A: To fill out Form DOH-5247, provide the required information about the Medicaid beneficiary, the authorized representative, and their relationship or authority to act on behalf of the beneficiary.

Q: How do I submit Form DOH-5247?A: You can submit Form DOH-5247 by mail, fax, or in person at your local Medicaid office in New York.

Q: What is the deadline for submitting Form DOH-5247?A: There is no specific deadline for submitting Form DOH-5247. However, it is recommended to submit it as soon as possible to ensure timely processing.

Q: Can I designate more than one authorized representative on Form DOH-5247?A: Yes, you can designate multiple authorized representatives on Form DOH-5247 by providing their information in the designated section of the form.

Q: Can I change my authorized representative at any time?A: Yes, you can change your authorized representative at any time by submitting a new Form DOH-5247 with the updated information.

Q: Is there a fee for submitting Form DOH-5247?A: No, there is no fee for submitting Form DOH-5247.