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Medicaid Primary Care Physicians' Certification and Attestation for Primary Care Rate Increase form

The Medicaid Primary Care Physicians' Certification and Attestation for Primary Care Rate Increase form has been revised. The revised form includes a new section for the primary care physician to identify if they are a Managed Care Program provider and which health plan(s) they provide services for.

The form is available on the Provider Enrollment Applications and Forms page of the MMAC website.