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Form DMS-2635 Medical Assistance Dental Disposition - Arkansas
What Is Form DMS-2635?
This is a legal form that was released by the Arkansas Department of Human Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DMS-2635?
A: Form DMS-2635 is a Medical Assistance Dental Disposition form used in Arkansas.
Q: What is the purpose of Form DMS-2635?
A: Form DMS-2635 is used to document dental services received by individuals enrolled in the Medical Assistance program in Arkansas.
Q: Who needs to fill out Form DMS-2635?
A: Dentists or dental providers who have provided services to individuals enrolled in the Medical Assistance program in Arkansas need to fill out Form DMS-2635.
Q: Is Form DMS-2635 specific to Arkansas?
A: Yes, Form DMS-2635 is specific to Arkansas and is used for documenting dental services in the state.
Q: What information is required on Form DMS-2635?
A: Form DMS-2635 requires information such as the recipient's name, Medicaid ID, dental service provided, date of service, and provider information.
Q: Are there any fees associated with Form DMS-2635?
A: No, there are no fees associated with Form DMS-2635. It is a documentation form for dental services.
Q: Can Form DMS-2635 be submitted electronically?
A: Yes, Form DMS-2635 can be submitted electronically through the Arkansas Medicaid Provider Portal.
Q: Is Form DMS-2635 mandatory for dental providers in Arkansas?
A: Yes, dental providers who offer services to individuals enrolled in the Medical Assistance program in Arkansas are required to fill out Form DMS-2635 to document the services provided.
Form Details:
- Released on November 3, 2015;
- The latest edition provided by the Arkansas Department of Human 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 DMS-2635 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Human Services.
