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Form DOH-4316 Assignment of Benefits - New York
What Is Form DOH-4316?
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-4316?A: Form DOH-4316 is the Assignment of Benefits form in New York.
Q: What is the purpose of Form DOH-4316?A: The purpose of Form DOH-4316 is to allow a healthcare provider to bill and receive payment directly from an insurance company on behalf of a patient.
Q: Who needs to fill out Form DOH-4316?A: The healthcare provider needs to fill out Form DOH-4316.
Q: Is Form DOH-4316 specific to New York?A: Yes, Form DOH-4316 is specific to New York.
Form Details:
- Released on October 1, 2011;
- 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;
- Fill out the form in our online filing application.
Download a printable version of Form DOH-4316 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
