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State of California Health and Human Services Agency Department of Health Care Services COUNTY MENTAL HEALTH PLAN (MHP) ANNUAL COUNTY MONITORING ACTIVITIES (ACMA) ATTESTATION FISCAL YEAR (FY) 2023/2024
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How to fill out enclosure 1 dhcs 1738
How to fill out enclosure 1 dhcs 1738
01
Obtain a copy of the DHCS 1738 form, also called the Medi-Cal Treatment Authorization Request form.
02
Fill out the patient's personal information, including their name, date of birth, and Medi-Cal ID number.
03
Provide information about the requested treatment, including the type of service, the diagnosis, and the start and end dates of the treatment.
04
Have the treating physician sign and date the form to indicate their authorization for the treatment.
05
Submit the completed Enclosure 1 DHCS 1738 form to the Medi-Cal office for processing.
Who needs enclosure 1 dhcs 1738?
01
Individuals who are seeking authorization for Medi-Cal covered treatments or services.
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What is enclosure 1 dhcs 1738?
Enclosure 1 DHCS 1738 is a form used to report financial information for Medi-Cal managed care plans.
Who is required to file enclosure 1 dhcs 1738?
Medi-Cal managed care plans are required to file enclosure 1 DHCS 1738.
How to fill out enclosure 1 dhcs 1738?
Enclosure 1 DHCS 1738 is filled out by entering financial information such as revenues, expenses, and membership data.
What is the purpose of enclosure 1 dhcs 1738?
The purpose of enclosure 1 DHCS 1738 is to provide the Department of Health Care Services with financial information regarding Medi-Cal managed care plans.
What information must be reported on enclosure 1 dhcs 1738?
Information such as revenues, expenses, and membership data must be reported on enclosure 1 DHCS 1738.
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