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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care ServicesINSTRUCTIONS FOR MEDICAL INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT (IHS/MOA) 638 CLINIC AND TRIBAL FEDERALLY
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To fill out the dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconciliation-request-instructions form, follow these steps:
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Fill in your personal information accurately, including your name, address, and contact details.
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Provide your organization's information, such as the name, address, and phone number.
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Enter the relevant dates and periods for the reconciliation request.
07
Provide details of the services rendered or claims being reconciled.
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dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconciliation-request-instructions is needed by healthcare organizations, specifically those operating under the Indian Health Services (IHS) or the 638 clinics, tribal clinics, and Federally Qualified Health Centers (FQHC). This form provides instructions for reconciling and requesting reimbursements for healthcare services provided within these organizations.
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The dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconcilation-request-instructions is a form used by Indian Health Services (IHS) clinics, Tribal clinics, and Federally Qualified Health Centers (FQHCs) to request reconciliation of claims with the California Department of Health Care Services (DHCS).
Indian Health Services (IHS) clinics, Tribal clinics, and Federally Qualified Health Centers (FQHCs) are required to file the dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconcilation-request-instructions.
The dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconcilation-request-instructions form can be filled out with detailed instructions provided by DHCS. Providers need to report specific information accurately to reconcile claims.
The purpose of dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconcilation-request-instructions is to reconcile claims between IHS clinics, Tribal clinics, FQHCs, and DHCS for proper payment processing.
On the dhcs-3098i-ihs-moa-638-clinic-tribal-fqhc-reconcilation-request-instructions form, providers must report detailed claim information, including patient details, services provided, dates of service, and billing codes.
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