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Dmas 97 Form

Dmas 97 Form

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Quick steps to complete and e-sign Dmas 97a b form online:

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Video instructions and help with filling out and completing Dmas 97 Form

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Instructions and help about dmas97

Welcome! This short video will explain how to complete the Primary Account Holder (PAH) Form to add or change a PAH. This form is applicable to any PAH who needs MES Provider Portal access, including individual providers currently enrolled in Virginia Medicaid but who do not yet have MES credentials. This form is accessed from the link  on the right side of the Provider Training page.   The URL for this page is https://vamedicaid.dmass.virginia.gov/training/providers. Other links on this page  provide additional information, such as FAQs   that you may find helpful when completing  this form. So let's take a look at the form now! The first page of the form provides  instructions and information to   consider when completing the form. Be sure  to read this page before completing the form   It indicates important details, such as needing  to submit one PAH form for each Entity Tax ID  enrolled with DMAS. This page also includes where  the form should be emailed or faxed

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