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(a) The department may enroll a provider of transportation or accommodation services as a Medicaid provider if the provider
(1) holds all certificates and licenses required by law to perform the services; and
(2) files with the department a completed copy of the department's Provider Enrollment Form , dated June, 2003.
(b) The department's Provider Enrollment Form , dated June, 2003, is adopted by reference.
History: Eff. 6/24/2004, Register 170
Authority: AS 47.05.010
Editor's note: A copy of the department's Provider Enrollment Form adopted by reference in 7 AAC 43.50 1(b) may be obtained from the department's designee, First Health Services Corporation, by telephone at 800-770-5650 (within Alaska but outside Anchorage) or 907-644-6800. The form may also be obtained at the First Health Services Corporation web site at http://Alaska.fhsc.com or by mail from the following address: First Health Services Corporation, Provider Enrollment, P.O. Box 240808, Anchorage, Alaska 99524-0808.
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Last modified 7/05/2006