Get Dhs 1139

The Dhs 1139 form is essential for applicants seeking to become providers in the Hawaii State Medicaid Program. This guide offers a clear, step-by-step approach to filling out the form online, ensuring that all users, regardless of their legal background, can navigate the process effortlessly.

Follow the steps to successfully complete the Dhs 1139 online.

1. Click ‘Get Form’ button to obtain the Dhs 1139 and open it in your preferred online editor.
2. Begin by reviewing all instructions provided with the form to gather necessary information and documents required for submission.
3. Complete the personal and professional information section, including your provider name, National Provider Identifier (NPI), and business information.
4. Fill out the section regarding your licensing information, ensuring that you attach any relevant copies of your licenses and certifications.
5. In the address information section, clearly indicate your correspondence address, service address, and pay-to address, ensuring all fields are complete.
6. Provide information about your specialty and any relevant background checks or certifications required by the Medicaid program.
7. Carefully review all the entries for accuracy, and make sure you have filled in all necessary sections, particularly the agreement and disclosure forms.
8. Once all sections are completed, save your changes, and prepare the final submission by downloading, printing, or sharing your completed Dhs 1139 online.

Complete your Dhs 1139 form online today to ensure your application process is smooth and efficient.