خانه ارائه دهندگان و شرکا دستورالعمل‌ها و الزامات درخواست پزشک مستقر در کلینیک​​ 

دستورالعمل ها و الزامات برنامه پزشک مبتنی بر کلینیک​​ 

شایستگی​​ 

این نوع ثبت‌نام فقط برای پزشکانی است که خدمات پزشکی را منحصراً در کلینیک‌های مراقبت‌های اولیه دارای مجوز ثبت‌نام Medi-Cal ارائه می‌کنند، هیچ مکان تجاری دیگری (به عنوان مثال مطب پزشکی) که در آن خدمات ارائه می‌کنند ندارند و باید صورت‌حساب خدمات بستری ارائه شده به ذینفعان در بیمارستان مراقبت‌های حاد عمومی یا بیمارستان حاد روان‌پزشکی را ارائه کنند. گروه ها برای این نوع ثبت نام واجد شرایط نیستند.​​ 

Pursuant to the regulatory Provider Bulletin published in the December 2005 Medi-Cal Update, DHCS has established procedures for the enrollment of physicians who are solely employed by or provide services pursuant to a contract with licensed primary care clinics, except for services provided as part of a graduate medical education program, and who do not have any active Medi-Cal provider number issued to them individually to bill for clinical services to Medi-Cal beneficiaries at another location and as such, use the licensed primary care clinic as their established place of business. This type of enrollment allows the physician to bill for inpatient services only and not for services provided at the Licensed Primary Care Clinic. In order to determine whether or not you qualify for this type of enrollment, please read the detailed Provider Bulletin: “Requirements and Procedures for ‘Clinic-Based Provider’ Enrollment”. ​​ 

 

If you qualify to enroll as a Clinic-Based Physician: Clinic-Based Physicians are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment). ​​ 

صدور مجوز​​ 

Prior to applying to Medi-Cal, first check the Medical Board of California or the Osteopathic Medical Board of California to ensure you meet all the licensing requirements.​​       

مدارک مورد نیاز​​ 

در مرحله بعد، مدارک مورد نیاز فهرست شده در زیر را جمع آوری کنید، تا زمانی که درخواست PAVE خود را تکمیل می کنید، آنها را در PAVE آپلود کنید. لطفا از خوانا بودن اسناد آپلود شده اطمینان حاصل کنید.​​ 

  1. Current California Medical License or Osteopathic Physician and Surgeon’s License of applicant or provider. Please include DEA Certificate, if applicable.​​ 
  2. Driver’s License or state-issued identification card (issued within the 50 United States or the District of Columbia) of the provider who is signing the application. The signature must be that of the physician applicant.​​  
  3. Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification of the physician applicant, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit the IRS or call them at (800) 829-4933.​​ 
  4. Licensed Primary Care Clinic Cover Letter from at least one Medi-Cal-enrolled clinic at which you provide services. This letter should include the required information as described on page three of the Clinic-Based Provider Bulletin.​​    
  5. Physician Cover Letter (at least one) that includes the required information as described on page four of the Clinic-Based Provider Bulletin. ​​  
  6. Fictitious Name Permit (FNP) issued by the Medical Board of California or the Osteopathic Medical Board of California, if using a fictitious name for your medical practice, as defined by the Board.  Note: The business name of the applicant or provider on the application, all local business licenses/permits, and the FNP must exactly match.​​ 
  7. If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation from the Secretary of State, and a list of directors’ and officers’ names and titles, with percent of ownership and control interest for each. To verify or change the name or status of your corporation, or for further information, please visit the Secretary of State California Business Portal select the “California Business Search” link or other appropriate link.​​ 
  8. گواهی بیمه مسئولیت حرفه ای به مبلغ حداقل 100000 دلار برای هر خسارت و حداقل مجموع سالانه 300000 دلار. تایید قابل قبول، گواهی بیمه یا برگه اظهارنامه صادر شده توسط شرکت بیمه است که حاوی نام شرکت بیمه، نام بیمه شده، تاریخ اجرا و حدود پوشش باشد. توجه: نام ارائه دهنده، همانطور که در مجوز پزشکی کالیفرنیا آمده است، باید در تأیید بیمه مسئولیت حرفه ای نیز نشان داده شود.​​ 

پورتال PAVE​​ 

به پورتال PAVE بروید.​​