CA DHCS 9096 2011-2025 free printable template

Dear Provider: Thank you for your participation in the Medical Dental Program (Identical). This Medical Change of Location Form For Individual Physician or Individual Dentist Practices Relocating

How to fill out medi cal change physician form

How to fill out CA DHCS 9096

1. Obtain the CA DHCS 9096 form from the Department of Health Care Services website.
2. Read the instructions on the form carefully to understand the requirements.
3. Fill out your personal information in the designated fields, including your name, address, and contact information.
4. Provide the required details regarding your healthcare services or organization.
5. If applicable, include the information of any authorized representatives.
6. Ensure all sections of the form are completed accurately and truthfully.
7. Review the filled form for any errors or missing information.
8. Sign and date the form as required.
9. Submit the completed form as instructed, either by mail or electronically, depending on the submission guidelines.

Who needs CA DHCS 9096?

1. Individuals or organizations applying for healthcare services under California's Medicaid program.
2. Providers seeking to become Medi-Cal certified.
3. Healthcare professionals who wish to enroll in Medi-Cal to offer services to eligible patients.

Video instructions and help with filling out and completing medi cal change form

Instructions and Help about ca dhcs9096 dentist search

Okay Arnett we've been listening this morning so far to what's going on at the national scene and now were going to talk about what's happening here in the state of California and for those of you who are actually listening to me thank you very much this is always the hardest part because I know we all love to talk to each other, so there will be a great opportunity at lunch and there's plenty more time at the reception this evening, so I'm going to introduce I want to make sure I'm saying it right Haney catch I originally said Haney she said no that's wrong its Haney, so now I have it correct she is the assistant deputy director for healthcare delivery systems at the California Department of Health Care Services and in that capacity she oversees the divisions that operate the operations quality and monitoring of managed care plans the long-term care programs and the systems of care program for vulnerable populations, so she clearly knows a lot about the work that we do, and she's had a very interesting kind of history and the various work that she's done not almost share some of that with you, she spent four years as Senator Frankel senior health policy advisor and primary health care staffer on the Senate health education labor and pensions committee also known as the help committee she then took a leadership role in developing several key pieces of legislation that were passed into law including the drug quality and Security Act of 2013 the Violence Against Women Act of 2013 and the Food and Drug Administration safety and innovation Act of 2012 she also worked closely with congressional leadership the US Department of Health and Human Services and the White House on implementation of Affordable Care Act, so she's got a great history that she brings to the state of California and I see why they snatched you up, so I'm going to turn this over to Haney catch who's going to share with us what's kind of the big picture of what's going on at the state level and then right after that were going to hear from the panel on mental health and substance abuse services from the department so come on it yours thank you so much I really appreciate the opportunity to be here today not just because I get to spend a short time in the beautiful San Diego weather but also to talk about one of my favorite subjects and, so thank you for that warm introduction I did and actually in the Senate a couple of pieces that I wanted to mention much of my work in the Senate focus yes sorry in the back Oh volume up okay sorry about that Ill speak up um much of my work in the Senate actually did also focus on mental health issues the senator that I worked for both senators that I worked for actually cared very much about mental health issues Senator Kennedy is the first one and senator Frankel, and so I actually was able to play a significant role in the 2008 mental health parity and addiction Equity Act as well as the mental health awareness and Improvement Act which just...

People Also Ask about medi cal form dentist

How can I change my address with Medi-Cal online?

To report changes, call Covered California at (800) 300-1506 or log in to your online account. You can also find a Licensed Insurance Agent, Certified Enrollment Counselor or county eligibility worker who can provide free assistance in your area.

What happens to Medi-Cal if I move?

You will not get Medi-Cal if you move out of California. You may apply for Medicaid in the state you move to. If you are moving to a new county in California, you also need to tell the county you live in or the county you are moving to. This is to make sure you keep getting Medi-Cal benefits.

How do I change my Medi-Cal from one county to another?

To report changes, call Covered California at (800) 300-1506 or log in to your online account. You can also find a Licensed Insurance Agent, Certified Enrollment Counselor or county eligibility worker who can provide free assistance in your area.

How long does it take to transfer Medi-Cal to another county?

the process might be completed in as little as 30 days. Counties sometimes have different processes, so ICTs work more smoothly between some counties than others. The customer will continue to receive benefits either way.

How long does inter county transfer take for Medi-Cal?

How Long Will the Process Take? the process might be completed in as little as 30 days. Counties sometimes have different processes, so ICTs work more smoothly between some counties than others. The customer will continue to receive benefits either way.

Can I use Medi-Cal in another city?

Medi-Cal rules are set up to help you receive uninterrupted coverage and benefits when you move from one California county to another. Your case will follow you to your new county of residence; this process is known as an “inter-county transfer” or ICT.

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What is CA DHCS 9096?

CA DHCS 9096 is a document required by the California Department of Health Care Services for reporting certain financial and programmatic information related to Medi-Cal.

Who is required to file CA DHCS 9096?

Entities that participate in the Medi-Cal program, including providers, clinics, and other healthcare organizations, are required to file CA DHCS 9096.

How to fill out CA DHCS 9096?

To fill out CA DHCS 9096, providers must complete the sections related to their organization, financial data, and services rendered, ensuring all information is accurate and up-to-date.

What is the purpose of CA DHCS 9096?

The purpose of CA DHCS 9096 is to collect necessary data that helps ensure compliance with Medi-Cal regulations, assess program performance, and facilitate financial reporting.

What information must be reported on CA DHCS 9096?

CA DHCS 9096 requires reporting information such as organization details, financial performance metrics, service delivery data, and compliance with Medi-Cal standards.