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This document serves as the Annual Revenue and Expenditure Report for Mental Health Services Act (MHSA) funds for the fiscal year 2022-23, specifically for Ventura County. It includes various worksheets
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How to fill out dhcs 1822 a
01
Gather necessary information such as personal details of the patient, date, and service information.
02
Start with the patient identification section and fill in the patient's name, date of birth, and Medi-Cal number.
03
Complete the services requested section, specifying the services or equipment being requested.
04
Provide the appropriate ICD-10 diagnosis codes related to the patient's condition.
05
Fill in the provider's name, NPI number, and contact information.
06
Indicate the duration of the requested services or equipment.
07
Review the completed form for accuracy and completeness before submission.
08
Submit the form to the appropriate Medi-Cal or DHCS office as instructed.
Who needs dhcs 1822 a?
01
Individuals who are seeking specific medical services or equipment through Medi-Cal.
02
Healthcare providers or institutions submitting requests for services on behalf of their patients.
03
Patients who are under the California Medi-Cal program and require prior authorization for services.
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What is dhcs 1822 a?
DHCS 1822 A is a form used by the California Department of Health Care Services (DHCS) for reporting information related to the reimbursement of Medi-Cal services.
Who is required to file dhcs 1822 a?
Providers who offer services reimbursable by Medi-Cal, as well as those who need to report cost reports for the services provided, are required to file the DHCS 1822 A form.
How to fill out dhcs 1822 a?
To fill out DHCS 1822 A, you need to provide specific details such as provider information, service categories, patient information, and the costs associated with the services provided. Instructions are available on the form itself and can also be found on the DHCS website.
What is the purpose of dhcs 1822 a?
The purpose of DHCS 1822 A is to collect necessary data from service providers to ensure accurate reimbursement for health services provided to Medi-Cal recipients.
What information must be reported on dhcs 1822 a?
The information that must be reported includes provider demographics, service types rendered, dates of service, total amounts charged, and any adjustments or payments already received.
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