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How to Become a HPBE provider
How to Become a HPBE provider
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HBPE Enrollment Instructions
Forms:
Word Version
PDF Version
Hospital Application to Determine Presumptive Eligibility for Medicaid
Hospital Application to Determine Presumptive Eligibility for Medicaid
Administrative User Agreement
Administrative User Agreement
Data Release Agreement
HIPAA Business Associate Agreement
Updated 7/2016
HIPAA Business Associate Agreement
Updated 7/2016
Hospital Application for HBPE Addendum
Hospital Application for HBPE Addendum