Form 470-5262 Iowa Medicaid Qualified Medicare Beneficiaries (Qmb) or Health Insurance Premium Payment (HIPP) Program Provider Enrollment Application - Iowa

What Is Form 470-5262?

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

FAQ

Q: What is the purpose of the Form 470-5262 Iowa Medicaid Qualified Medicare Beneficiaries (Qmb) or Health Insurance Premium Payment (HIPP) Program Provider Enrollment Application?
A: The purpose of this form is to enroll providers in the Iowa Medicaid Qualified Medicare Beneficiaries (QMB) or Health Insurance Premium Payment (HIPP) Program.

Q: Who can use this form?
A: Providers who wish to participate in the Iowa Medicaid Qualified Medicare Beneficiaries (QMB) or Health Insurance Premium Payment (HIPP) Program can use this form.

Q: What programs does this form cover?
A: This form covers the Iowa Medicaid Qualified Medicare Beneficiaries (QMB) and Health Insurance Premium Payment (HIPP) Programs.

Q: What information is required on this form?
A: The form requires providers to provide their personal information, professional credentials, contact information, and other details related to their practice.

Q: How can I submit this form?
A: This form can be submitted by mail or fax to the Iowa Medicaid Enterprise Provider Enrollment Unit.

Q: Is there a fee to submit this form?
A: No, there is no fee required to submit this form.