Get the free SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST - dhcs ca
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This document is a claim form used by California counties to request reimbursement for treatment costs under the Medi-Cal program, certifying the services rendered and the expenditures made.
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How to fill out SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST
01
Obtain the SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST form.
02
Fill in your agency's name and contact information at the top of the form.
03
Enter the provider number associated with your agency.
04
In the 'Claim Period' section, input the month and year for which you are filing the claim.
05
List all eligible clients receiving treatment during the claim period, including their Medi-Cal numbers.
06
Detail the services provided to each client, including dates of service and the number of units billed.
07
Calculate the total cost for each service and enter the subtotal in the designated section.
08
Add all subtotals to obtain the total claim amount.
09
Sign and date the form to certify that the information is complete and accurate.
10
Submit the completed form to the appropriate Medi-Cal claims processing agency.
Who needs SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
01
Mental health service providers who offer services covered by Medi-Cal.
02
Organizations and agencies providing treatment to Medi-Cal beneficiaries.
03
Any healthcare professionals seeking reimbursement for treatment costs under the SHORT-DOYLE/MEDI-CAL program.
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What is SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
The SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST is a billing form used by healthcare providers in California to request reimbursement for mental health treatment services provided to Medi-Cal beneficiaries.
Who is required to file SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
Providers of mental health services who are enrolled in the Medi-Cal program are required to file the SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM for reimbursement for the services they render to eligible clients.
How to fill out SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
To fill out the claim, providers must enter details such as patient information, treatment dates, types of services rendered, procedure codes, and costs incurred. It's vital to ensure accuracy and completeness to avoid rejections.
What is the purpose of SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
The purpose of this claim form is to obtain reimbursement from the Medi-Cal program for mental health treatment services provided to eligible individuals, ensuring that providers are compensated for their services.
What information must be reported on SHORT-DOYLE/MEDI-CAL MONTHLY CLAIM FOR REIMBURSEMENT TREATMENT COST?
The information that must be reported includes the provider's identification details, patient demographics, service dates, types of treatment provided, associated procedure codes, and the total cost of services rendered.
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