Get the free Out-of-State Provider Express Enrollment - Medi-Cal - State of ... - files medi-cal ca

State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS Director EDMUND G. BROWN JR. Governor Out-of-State Provider Express Enrollment Form Dear Out-of-State Provider in order to enroll as an out-of-state Medi-Cal provider the following information is required Please attach this form to your original claim and mail in. Provider/Facility Name Ambulance circle one Air Ground circle one M.

How to fill out out-of-state provider express enrollment

How to fill out out-of-state provider express enrollment:

1. Visit the website of the out-of-state provider express enrollment portal.
2. Click on the option to start a new enrollment application.
3. Provide your personal information such as name, contact details, and address.
4. Enter the details of your out-of-state provider, including their name, address, and contact information.
5. Submit any required documents, such as proof of licensure or certification for your out-of-state provider.
6. Review and confirm the information you have entered before submitting the application.
7. Wait for confirmation from the enrollment portal regarding the status of your application.

Who needs out-of-state provider express enrollment:

1. Healthcare providers who wish to offer services outside of their home state.
2. Clinics or medical facilities looking to hire out-of-state healthcare professionals.
3. Patients seeking care from healthcare providers located in a different state than their own.

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What is out-of-state provider express enrollment?

Out-of-state provider express enrollment is a process for providers from another state to quickly enroll in a healthcare network.

Who is required to file out-of-state provider express enrollment?

Providers from other states who wish to participate in a healthcare network are required to file out-of-state provider express enrollment.

How to fill out out-of-state provider express enrollment?

Out-of-state provider express enrollment can be filled out online through the healthcare network's website.

What is the purpose of out-of-state provider express enrollment?

The purpose of out-of-state provider express enrollment is to streamline the enrollment process for out-of-state providers and improve access to healthcare services.

What information must be reported on out-of-state provider express enrollment?

Out-of-state provider express enrollment typically requires information such as provider's credentials, contact information, and license details.