Transcription of Provider Initial Enrollment Instructions Individuals …
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Provider Initial Enrollment Instructions Individuals …
_____ FA-31C-I: Provider Initial Enrollment Instructions ( Individuals ) Page 1 of 3 04/12/2013 Nevada Medicaid and Nevada Check Up This document provides Instructions for completing the Provider Initial Enrollment Application for Individual providers. Please answer all questions as of the current date. Attach additional sheets if necessary to answer each question completely. Each additional sheet must display the relevant question number from the application. These Instructions are designed to clarify certain questions on the application. Instructions are listed in question order for easy reference. No Instructions have been given for questions considered self-explanatory. Section 1: General Information Question 4 ( Enrollment Effective Date) Enter the date on which you wish the Provider Enrollment to begin.
FA-31C-I: Provider Initial Enrollment Instructions (Individuals) Page 2 of 3 04/12/2013 A specialty is required for provider types 14, …
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