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Gateway prior auth form

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The document is a Provider Data Form for Gateway Health, intended for healthcare providers applying to participate in Medicaid and Medicare. It outlines the required information needed for the application process, including personal details, practice information, and credentialing requirements. The form emphasizes the importance of completing it accurately and provides instructions for submission and additional resources related to credentialing.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (56 Votes)

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