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This document is an application form for enrollment or continued enrollment as a provider in the Medi-Cal program in California. It outlines the process, required documents, and instructions for applicants
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How to fill out medi-cal provider group application
How to fill out Medi-Cal Provider Group Application
01
Obtain the Medi-Cal Provider Group Application form from the California Department of Health Care Services website.
02
Fill out the application form with accurate information regarding your provider group’s details.
03
Provide the names and qualifications of all providers in the group.
04
Include the National Provider Identifier (NPI) for each provider.
05
Ensure that all required documentation, such as licenses and certifications, is included with the application.
06
Review the completed application for any errors or missing information.
07
Submit the completed application and documents via the indicated method (mail, fax, or online).
08
Wait for confirmation of receipt from Medi-Cal and follow up if necessary.
Who needs Medi-Cal Provider Group Application?
01
Healthcare providers looking to enroll as a group in the Medi-Cal program.
02
Medical practices that want to provide services to Medi-Cal beneficiaries.
03
Organizations seeking to obtain reimbursement for medical services provided to eligible patients.
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People Also Ask about
What is Medi-Cal called in California?
Medi-Cal is California's Medicaid health care program.
How to contact Medi-Cal in California?
Telephone Service Center 1-800-541-5555 The Telephone Service Center (TSC) is available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.
Can I apply for Medi-Cal over the phone in California?
You can also apply in person at your local county human services agency or by phone by calling Covered California at (800) 300-1506, or use one of our certified enrollers.
What documents are needed to apply for Medi-Cal in California?
What information do I need? California Driver's License or Identification Card. Proof of California Residency. Immigration status. Birth Certificates, passports, naturalization certificates. Social Security and Medicare Card.
What is the maximum income to qualify for Medi-Cal?
Medi-Cal Categories You are 19-64 years old and your family's income is at or below 138% of the Federal Poverty Level (FPL) ($21,597 for an individual; $44,367 for a family of four). You are a child 18 or younger and your family's income is at or below 266% of FPL ($85,519 per year for a family of four).
How can I check if my Medi-Cal is active in California?
Contact the Medi-Cal office in your county to check on the status of your application or ask questions. It's also important to keep the county updated on information about your family, especially for changes such as: change of address, marriage, divorce, birth or gaining health coverage through another source.
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What is Medi-Cal Provider Group Application?
The Medi-Cal Provider Group Application is a form used to enroll a group of healthcare providers in the Medi-Cal program, which offers health care services to eligible low-income individuals and families in California.
Who is required to file Medi-Cal Provider Group Application?
Healthcare groups, clinics, or organizations that wish to provide services to Medi-Cal beneficiaries must file the Medi-Cal Provider Group Application.
How to fill out Medi-Cal Provider Group Application?
To fill out the Medi-Cal Provider Group Application, one should gather relevant information about the group, including provider information, licensing details, and proof of qualifications, then complete the required sections of the application form accurately.
What is the purpose of Medi-Cal Provider Group Application?
The purpose of the Medi-Cal Provider Group Application is to establish a formal enrollment process for groups of providers, ensuring they meet the necessary requirements to deliver healthcare services under the Medi-Cal program.
What information must be reported on Medi-Cal Provider Group Application?
The application must report information such as the names and credentials of the group members, group tax identification numbers, practice locations, and any relevant certifications or licenses held by the providers.
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