Pif provider form 2025

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4.8 out of 5

122 votes

The Provider Information Form (PIF-1) is a mandatory document for all providers seeking enrollment in Texas Medicaid. It requires comprehensive information about the provider, including personal details, professional licenses, and any previous sanctions or criminal convictions. Providers must also complete a Principal Information Form (PIF-2) for each principal associated with the provider entity. High-categorical risk providers are required to submit fingerprints for enrollment or revalidation. The form emphasizes the importance of accuracy and completeness in the information provided.

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Click ‘Get Form’ to open the pif provider form in the editor.
Begin by entering the 'Name of Provider Enrolling' at the top of the form. Ensure you include any aliases or previous names used.
Fill in your National Provider Identifier (NPI) and Taxonomy Codes. If you have multiple taxonomy codes, attach additional pages as necessary.
Complete the 'Physical Address' section accurately, as this is where healthcare services are rendered. Avoid using accounting addresses here.
If applicable, provide details about your professional licenses and certifications, including issue and expiration dates.
Answer all questions regarding sanctions, criminal history, and child support obligations truthfully. Attach additional sheets if needed for explanations.
Review all entered information for accuracy before signing the certification at the end of the form.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (122 Votes)
2015	4 Satisfied (60 Votes)
2014	3.8 Satisfied (31 Votes)

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What is a PIF form?

Program Information Forms (PIFs) provide Visa information on your Debit or Credit program in order to perform due diligence, manage risk, and evaluate programs to ensure alignment with overall business goals.

What does PIF mean in medical billing?

PIF = paid in full.