What is a disclosing entity?

Disclosing entity means: (1) A provider of services, an independent clinical laboratory, a renal disease facility, a rural health clinic, a Federally qualified health center, or a health maintenance organization (as defined in section 1301(a) of the Public Health Service Act);

What is ownership disclosure?

The Disclosure of Ownership is a Center for Medicare and Medicaid Services (CMS) and Client Required document to obtain during the contracting/credentialing process. If this documentation is not received, the credentialing process will be delayed.

What is the Texas Medicaid disclosure of ownership form?

Form 5871-S is completed and submitted as a condition of approval or renewal of a Texas Medicaid enrollment application or a contract agreement between the disclosing entity (applicant/provider) and HHSC for any services program. A full and accurate disclosure of ownership and control interest is required.

What is a disclosing entity?

Disclosing entity means: (1) A provider of services, an independent clinical laboratory, a renal disease facility, a rural health clinic, a Federally qualified health center, or a health maintenance organization (as defined in section 1301(a) of the Public Health Service Act);

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Disclosure Of Ownership Form

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new statement must be submitted when any information in your statement has changed. You should complete this form in conjunction with review of the requirements for disclosure of ownership, business transactions and exclusions of individuals and entities from government programs as provided in the MCO’s administrative requirements. This statement must be completed whether or not you have any information to report. If more space is needed, please attach additional information. For assistance i.

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