Transcription of Provider Revalidation Instructions (Individuals) - …
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Provider Revalidation Instructions (Individuals) - …
_____ FA-31A-I: Provider Revalidation Instructions ( individuals ) Page 1 of 3 04/12/2013 nevada medicaid and nevada Check Up This document provides Instructions for completing the Provider Revalidation Application for Individual providers who have received a Revalidation letter. 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 (Group Membership) If you would like to become a member of an existing Provider Group, enter the group s National Provider Identifier (NPI) and the date you would like to be affiliated with the group.
FA-31A-I: Provider Revalidation Instructions (Individuals) Page 1 of 3 04/12/2013 Nevada Medicaid and Nevada Check Up
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