Get the free NEW SHORT-DOYLE/MEDI-CAL PROVIDER CERTIFICATION APPLICATION DHCS 1736 (Rev. 09/2014)...
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State of California Health and Human Services Agency Department of Health Care Services COUNTY-OWNED AND OPERATED PROVIDER CERTIFICATION APPLICATION PART I: PROVIDER INFORMATION Instructions: The
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How to fill out new short-doylemedi-cal provider certification
How to fill out the new short-Doyle Medi-Cal provider certification:
01
Begin by obtaining the necessary application form from the appropriate agency or organization.
02
Fill in all required personal information, such as your name, address, contact information, and social security number.
03
Provide details about your professional qualifications, including education, training, and any relevant certifications or licenses.
04
Include information about your practice or organization, such as the name, address, and contact details.
05
Indicate the types of services you are qualified to provide under the Medi-Cal program.
06
Provide any additional supporting documentation requested, such as proof of malpractice insurance or documentation of your professional experience.
07
Review the completed application for accuracy and completeness before submitting it to the designated agency or organization.
Who needs new short-Doyle Medi-Cal provider certification?
01
Healthcare providers who wish to participate in the Medi-Cal program.
02
Individuals or organizations that offer services covered by Medi-Cal and want to be reimbursed for those services.
03
Professionals who are eligible to bill Medi-Cal for services rendered, such as physicians, dentists, therapists, and clinics.
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What is new short-doylemedi-cal provider certification?
The new short-doylemedi-cal provider certification is a form that providers must fill out and submit to become certified to provide services to short-doylemedi-cal beneficiaries.
Who is required to file new short-doylemedi-cal provider certification?
All healthcare providers who wish to provide services to short-doylemedi-cal beneficiaries are required to file the new certification form.
How to fill out new short-doylemedi-cal provider certification?
Providers can fill out the new short-doylemedi-cal provider certification form online or by mail, providing all requested information accurately.
What is the purpose of new short-doylemedi-cal provider certification?
The purpose of the new short-doylemedi-cal provider certification is to ensure that providers meet the necessary qualifications to deliver effective care to short-doylemedi-cal beneficiaries.
What information must be reported on new short-doylemedi-cal provider certification?
Providers must report their credentials, qualifications, contact information, and any other relevant details requested on the certification form.
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