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FOR BHF USELL1 2015 STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2015)I.DPH License ID Number: Facility

How to fill out medi-cal supplemental cost report

How to fill out medi-cal supplemental cost report

1. Review the instructions provided by Medi-Cal for filling out the supplemental cost report.
2. Gather all necessary financial documents and invoices related to the services provided.
3. Complete the basic information section of the form, including the provider's name, address, and Medi-Cal provider number.
4. Fill out the cost details section, listing all the services provided and their associated costs.
5. Ensure that all costs are accurately reported and supported by appropriate documentation.
6. Calculate the total cost for each service and enter the sum in the designated fields.
7. Include any additional relevant information or explanations, if necessary.
8. Review the completed form for accuracy and completeness.
9. Submit the filled-out supplemental cost report to the appropriate Medi-Cal office by the specified deadline.
10. Maintain copies of the submitted report and all supporting documentation for future reference or audits.

Who needs medi-cal supplemental cost report?

1. Healthcare providers who participate in the Medi-Cal program and have incurred supplemental costs for providing services.
2. Facilities or organizations that offer services covered by Medi-Cal and have additional expenses not fully reimbursed.
3. Entities seeking reimbursement for the eligible costs associated with the provision of healthcare services.
4. Those who have received prior approval from Medi-Cal to submit a supplemental cost report.
5. Providers or organizations that need to demonstrate their financial impact due to the provision of Medi-Cal services.

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What is medi-cal supplemental cost report?

The medi-cal supplemental cost report is a financial document that healthcare providers submit to report additional costs related to providing care to Medi-Cal patients.

Who is required to file medi-cal supplemental cost report?

Healthcare providers who offer services to Medi-Cal patients and incur extra costs beyond what is covered by standard billing are required to file the medi-cal supplemental cost report.

How to fill out medi-cal supplemental cost report?

Healthcare providers must accurately report all additional costs incurred while providing care to Medi-Cal patients on the medi-cal supplemental cost report form provided by the state.

What is the purpose of medi-cal supplemental cost report?

The purpose of the medi-cal supplemental cost report is to ensure that healthcare providers are properly reimbursed for all the costs associated with treating Medi-Cal patients.

What information must be reported on medi-cal supplemental cost report?

Healthcare providers must report all additional costs, such as overhead expenses, equipment costs, and other related expenses incurred while providing care to Medi-Cal patients.