CA HCBS-10 2010 free printable template
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Medical In-Home Operations Branch Home- and Community-Based Services (HUBS) Manual Plan of Treatment (POT) 1. Enclosure 5A APPLICANT/PARTICIPANT INFORMATION Name: IN: Last DOB: Address: Phone #: City
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How to fill out CA HCBS-10
How to fill out CA HCBS-10
01
Obtain the CA HCBS-10 form from the appropriate health care or state website.
02
Read the instructions carefully to understand the requirements.
03
Fill in the applicant's personal information, including name, address, and contact details.
04
Provide details about the service need and the qualifications of the service provider.
05
Include any relevant medical information or supporting documentation as required.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form where indicated.
08
Submit the completed form to the required agency or office.
Who needs CA HCBS-10?
01
Individuals who are applying for home- and community-based services in California.
02
Caregivers or service providers seeking to assist eligible individuals.
03
Health care professionals involved in supporting patients who require these services.
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How do I notify Medi-Cal of changes?
For Medi-Cal, you must report it within 10 days. To report changes, call Covered California at (800) 300-1506 or sign 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 do I submit a bill to Medi-Cal?
(800) 541-5555 (outside of California, please call 916-636-1980) or online at "Contact Medi-Cal". For the most current information about billing and claims submission, refer to the "Medi-Cal Newsroom" area on the Medi-Cal home page. 4.
What happens if you don't report a change to Medi-Cal?
If you do not report changes to your personal information right away, and then receive Medi-Cal benefits that you do not qualify for, you may have to repay DHCS. 19. You, or any family member receiving Medi-Cal, must not be getting public assistance from another state.
How do I update my Medi-Cal information?
For Medi-Cal, you must report it within 10 days. To report changes, call Covered California at (800) 300-1506 or sign 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 do I contact Dhcs Medi-Cal?
(800) 977-2273 Medi-Cal Rx Members and Providers: If you have a question, need help, or need to report a problem, please call (800) 977-2273 for our Medi-Cal Rx Customer Service Center (CSC).
What are the two types of Medi-Cal?
California offers two ways to get health coverage. They are “Medi-Cal” and “Covered California.” Both programs use the same application.
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What is CA HCBS-10?
CA HCBS-10 is a form used in California for reporting Home and Community-Based Services provided to individuals with specific needs or disabilities.
Who is required to file CA HCBS-10?
Healthcare providers and agencies that offer Home and Community-Based Services in California are required to file CA HCBS-10.
How to fill out CA HCBS-10?
To fill out CA HCBS-10, providers must complete all required sections including service details, client information, and provider information, ensuring that all fields are accurately filled based on the client's service history.
What is the purpose of CA HCBS-10?
The purpose of CA HCBS-10 is to document and report the services provided to clients in home and community settings, allowing for proper oversight and funding of these services.
What information must be reported on CA HCBS-10?
Information that must be reported on CA HCBS-10 includes client identification data, types of services provided, dates of service, and provider information.
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