TX HHS Form 3028. Hemophilia Assistance Program (HAP) Provider Enrollment

The TX HHS Form 3028, Hemophilia Assistance Program (HAP) Provider Enrollment, is a crucial document for healthcare providers seeking to participate in the Texas Hemophilia Assistance Program. This form helps solve the problem of enrolling as a provider for the program, ensuring that patients receive necessary care and treatment.

This form requires key information from providers, including facility type, provider name, National Provider Identifier (NPI), Tax ID number, and physical address. Important sections include general information, business information, and provider information. The form also asks about Medicaid participation, with options for direct deposit if applicable. Common scenarios of use involve pharmacy, hospital, or blood bank providers seeking to enroll in the program.

The TX HHS Form 3028 is essential for healthcare providers looking to participate in the Hemophilia Assistance Program (HAP). By completing this form, providers can ensure a smooth enrollment process and begin providing necessary care and treatment to patients. For more information or assistance with this form, please refer to relevant Texas Health and Human Services (HHS) guidelines.