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Form HFS1413A Waiver Program Provider Agreement for Participation in the Illinois Medical Assistance Program - Illinois
What Is Form HFS1413A?
This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HFS1413A?A: Form HFS1413A is a waiver programprovider agreement for participation in the Illinois Medical Assistance Program.
Q: What is the purpose of Form HFS1413A?A: The purpose of Form HFS1413A is to establish an agreement between a provider and the Illinois Medical Assistance Program for participation in the program's waiver program.
Q: Who needs to fill out Form HFS1413A?A: Providers who wish to participate in the waiver program of the Illinois Medical Assistance Program need to fill out Form HFS1413A.
Q: Are there any fees associated with Form HFS1413A?A: There are no fees associated with completing and submitting Form HFS1413A.
Form Details:
- Released on April 1, 2014;
- The latest edition provided by the Illinois Department of Healthcare and Family 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 HFS1413A by clicking the link below or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.
Download Form HFS1413A Waiver Program Provider Agreement for Participation in the Illinois Medical Assistance Program - Illinois
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