212.000 Practice Enrollment (Arkansas Medicaid PCMH Manual) A physician may be affiliated with only one participating practice. A participating practice must update the Department of Human Services (DHS) on changes to the list of physicians who are part of the practice. Physicians who are no longer participating with a practice are required to update in writing via email at [email protected] within 30 days of the change. The update/change form is located on the Payment Initiative website - http://www.paymentinitiative.org/Websites/paymentinitiative/images/Update-Change%20Form.pdf. This form should be completed and submitted to [email protected] when: • You have a provider leaving your practice • You have a provider joining your practice • Your contact lead(s) contact information changes
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212.000 Practice Enrollment (Arkansas Medicaid PCMH Manual) A physician may be affiliated with only one participating practice. A participating practice must update the Department of Human Services (DHS) on changes to the list of physicians who are part of the practice. Physicians who are no longer participating with a practice are required to update in writing via email at [email protected] within 30 days of the change. The update/change form is located on the Payment Initiative website - http://www.paymentinitiative.org/Websites/paymentinitiative/images/Update-Change%20Form.pdf. This form should be completed and submitted to [email protected] when:
• You have a provider leaving your practice • You have a provider joining your practice • Your contact lead(s) contact information changes
mailto:[email protected]://www.paymentinitiative.org/Websites/paymentinitiative/images/Update-Change Form.pdfmailto:[email protected]
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