Form SFN615 Medicaid Program Provider Agreement - North Dakota

What Is Form SFN615?

This is a legal form that was released by the North Dakota Department of Health and Human Services - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the SFN615 Medicaid Program Provider Agreement?
A: The SFN615 Medicaid Program Provider Agreement is a form used in North Dakota to establish an agreement between a healthcare provider and the state's Medicaid program.

Q: What is the purpose of the SFN615 Medicaid Program Provider Agreement?
A: The purpose of the agreement is to outline the terms and conditions under which the healthcare provider will provide services to Medicaid beneficiaries in North Dakota.

Q: Who needs to complete the SFN615 Medicaid Program Provider Agreement?
A: Healthcare providers who wish to participate in the North Dakota Medicaid program need to complete and submit the SFN615 form.

Q: What information is required in the SFN615 Medicaid Program Provider Agreement?
A: The agreement requires information such as the provider's name, address, provider type, National Provider Identifier (NPI), tax ID, and acceptance of Medicaid payment terms.

Q: Are there any fees associated with the SFN615 Medicaid Program Provider Agreement?
A: There are no fees associated with completing and submitting the SFN615 form. However, healthcare providers may be subject to applicable fees or rates set by the North Dakota Department of Human Services for their services.

Q: Can I cancel or terminate the SFN615 Medicaid Program Provider Agreement?
A: Yes, healthcare providers can cancel or terminate the agreement by submitting a written notice to the North Dakota Department of Human Services. The agreement may also be terminated or suspended by the department for various reasons.