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Click ‘Get Form’ to open the DP 1059 in the editor.
Select whether you are a New Provider, Existing Provider, or updating to add a specialty. This choice will determine which sections you need to complete.
In Section 1, enter your provider information including your name, MPI number, and contact details. Ensure accuracy as this information is crucial for processing.
Move to Section 2 and review the attestations. Indicate 'Yes' or 'No' based on your compliance capabilities. Remember, selecting 'No' will prevent qualification.
In Section 3, choose the Provider Type and Specialty from the dropdown menus. If applicable, check for enhanced service levels and provide any necessary comments.
Once completed, save your document using the format: ProviderName_DP1059_DateOfSubmission and submit it along with required documentation to your assigned Administrative Entity (AE).

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How can I eSign my odp provider qualification form from Gmail?

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How do you complete odp provider qualification documentation record on Android?

It is a no-brainer on a computer or via a mobile device to fill out a odp provider qualification documentation record with DocHub. All you need to do is open any installed browser on your smartphone and proceed to the DocHub site. Once authenticated, add your file and open it in editing mode. Use our toolbar to make your edits and save modifications. Optionally, keep your document in your files or send it to a recipient on the spot.

What does ODP stand for in Pennsylvania?

The Office of Developmental Programs (ODP) has committed to the individuals who receive services through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and to the federal Centers for Medicare and Medicaid Services (CMS) that all waiver providers will be deemed qualified to provide ...

What is a DP 1059?

The DP 1059 is a required attachment to enrollment application for: New specialties New sites Re-validation New specialties must be qualified on the DP 1059 prior to enrollment & attached. The attached DP 1059 must indicate that the specialty rendered at the site is qualified.

What is the Office of Developmental Programs PA?

The Pennsylvania Office of Developmental Programs is a bureau within the Department of Public Welfare. They are responsible for the establishment of policy and regulations which govern the mental retardation community program.

dp 1059

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What is a DP 1059?

The DP 1059 is a required attachment to enrollment application for: New specialties New sites Re-validation New specialties must be qualified on the DP 1059 prior to enrollment & attached. The attached DP 1059 must indicate that the specialty rendered at the site is qualified.

What does ODP stand for in PA?

The Office of Developmental Programs (ODP) has committed to the individuals who receive services through the Consolidated, Community Living and Person/Family Directed Support (P/FDS) Waivers and to the federal Centers for Medicare and Medicaid Services (CMS) that all waiver providers will be deemed qualified to provide ...

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What does ODP stand for in Pennsylvania?

What is a DP 1059?

What is the Office of Developmental Programs PA?

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