OWCP-1168 Web vers Provider Enrollment For, Screen Shots
Provider Enrollment Form
Screen shots of Billing Contractor Web Portal
Provider Enrollment Form
OMB: 1240-0021
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0021 can be found here:
Document [docx]
Download: docx | pdf
Billing Contractor’s Web Portal
Billing Contractor’s Web Portal – Provider Enrollment
Billing Contractor’s Web Portal – Online Enrollment
Billing Contractor’s Web Portal – Online Enrollment (once accept the participation agreement)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | yferguso |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |
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