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Form HCA09-048 Medicaid Provider Disclosure Statement - Washington
What Is Form HCA09-048?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HCA09-048?A: Form HCA09-048 is the Medicaid Provider Disclosure Statement for Washington State.
Q: Who needs to fill out Form HCA09-048?A: Medicaid providers in Washington State need to fill out Form HCA09-048.
Q: What is the purpose of Form HCA09-048?A: Form HCA09-048 is used to disclose information about the provider's ownership, control, and affiliations.
Q: How do I fill out Form HCA09-048?A: You need to provide information about your ownership, control, and affiliations, as well as sign and date the form.
Q: What happens after I fill out Form HCA09-048?A: The Washington State Health Care Authority will review your disclosure and determine if any further action is needed.
Q: Is there a deadline for submitting Form HCA09-048?A: Yes, you must submit Form HCA09-048 within 30 days of becoming a Medicaid provider in Washington State.
Q: Are there any fees associated with Form HCA09-048?A: No, there are no fees associated with submitting Form HCA09-048.
Form Details:
- Released on November 1, 2012;
- The latest edition provided by the Washington State Health Care Authority;
- 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 HCA09-048 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form HCA09-048 Medicaid Provider Disclosure Statement - Washington
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