Form DHS-4049-ENG Billing Intermediaries, Clearinghouses and Edi Trading Partners Provider Enrollment Application - Minnesota Health Care Programs (Mhcp) - Minnesota

Preview

Fill PDF Online

PDF

Word

Fill PDF Online

Fill out online for free

without registration or credit card

What Is Form DHS-4049-ENG?

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

FAQ

Q: What is the DHS-4049-ENG form?A: The DHS-4049-ENG form is the Provider Enrollment Application for Billing Intermediaries, Clearinghouses, and EDI Trading Partners in Minnesota Health Care Programs (MHCP)

Q: Who is required to fill out the DHS-4049-ENG form?A: Billing intermediaries, clearinghouses, and EDI trading partners who want to enroll in Minnesota Health Care Programs (MHCP) are required to fill out this form.

Q: What are Minnesota Health Care Programs (MHCP)?A: Minnesota Health Care Programs (MHCP) are a collection of health care programs provided by the state of Minnesota to eligible residents.

Q: What is the purpose of the DHS-4049-ENG form?A: The purpose of the DHS-4049-ENG form is to allow billing intermediaries, clearinghouses, and EDI trading partners to enroll in Minnesota Health Care Programs (MHCP) and participate in electronic data interchange.

Form Details:

Released on November 1, 2021;
The latest edition provided by the Minnesota 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 DHS-4049-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.