Kev taw qhia kev sau npe
Tsev Kho Mob thiab Chaw Kho Mob Kws Kho Mob COVID-19 Cov Neeg Ua Haujlwm Tuav Nyiaj Them Nqi
Cov Chaw Pabcuam Kev Pabcuam (CEs), Cov Chaw Pabcuam Kev Pabcuam (CSEs), thiab Pawg Kws Khomob (PGEs) yog txhua tus yuav tsum tau sau npe nrog Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) txhawm rau koom nrog hauv Tsev Kho Mob thiab Chaw Pabcuam Kws Kho Mob COVID-19 Cov Neeg Ua Haujlwm Retention Payments (WRP). Thaum sau npe, CEs, CSEs, thiab PGEs yuav raug pom zoo los thov cov nyiaj tuav pov hwm sawv cev ntawm cov neeg ua haujlwm tsim nyog.
Kev taw qhia dav dav:
Kev tso npe qhib rau lub Kaum Hlis 21, 2022, thiab kaw rau lub Kaum Ob Hlis 23, 2022. CEs, CSEs, thiab PGEs raug txhawb kom ua tiav kev sau npe ntxov kom tsis txhob ncua kev pom zoo.
Ib qhov txuas mus rau daim ntawv sau npe yuav muaj nyob rau ntawm Lub Tsev Kho Mob thiab Lub Chaw Pabcuam Saib Xyuas Neeg Mob Zoo COVID-19 Cov Neeg Ua Haujlwm Retention Payments lub vev xaib thaum Lub Kaum Hli 21.
Txhua lub koom haum yuav tsum ua kom tiav thiab xa Daim Ntawv Foos STD 204, Tus Neeg Them Cov Ntaub Ntawv Cov Ntaub Ntawv thaum lub sijhawm sau npe, txawm tias ib tus twb tau ua ntaub ntawv nrog Lub Xeev California lawm.
Yog tias koj yog ib feem ntawm lub network loj, kab ke kev noj qab haus huv, lossis pab pawg kho mob, koj tuaj yeem sau npe siv cov ntaub ntawv los ntawm koj qhov chaw loj tshaj plaws / lub koom haum (nrog cov neeg ua haujlwm coob tshaj plaws) thiab sau npe ib zaug.
Cov Chaw Ua Haujlwm Pabcuam Kev Pabcuam (saib cov ntsiab lus hauv qab no) yuav raug hais kom xa cov ntawv theej hluav taws xob ntawm koj daim ntawv cog lus Kev Pabcuam uas tau kos npe nrog Cov Chaw Pabcuam / Cov Chaw Tsim Nyog hauv Word (doc, docx) lossis PDF hom. Lub kaw lus lees txais ib daim ntawv ua ke nrog cov ntaub ntawv siab tshaj plaws ntawm 16 MB.
Tsuas yog cov kws kho mob ywj pheej, cov neeg ua haujlwm yuav tsum tsis txhob thov ncaj qha. Cov chaw tsim nyog, chaw ua haujlwm, thiab pab pawg kws kho mob yog lub luag haujlwm los thov cov nyiaj khaws cia rau lawv cov neeg ua haujlwm tsim nyog thiab cov kws kho mob.
Nyob ntawm hom chaw, muaj kwv yees li 15 yam khoom yuav tsum ua kom tiav ntawm daim ntawv sau npe. Thov saib Daim Ntawv Ntxiv rau cov ntaub ntawv xav tau.
Kwv yees lub sijhawm ua tiav yog 15 feeb.
Hauv 10 hnub ua haujlwm ntawm kev sau npe, ua tiav CEs, CSEs, PGEs thiab Cov Kws Kho Mob ywj pheej koj yuav tau txais email lees paub nrog qhov txuas rau daim ntawv thov. Yog tias koj tsis tau txais email lees paub thiab/lossis ib qhov txuas rau daim ntawv thov nyob rau lub sijhawm no, thov xa email rau DHCS ntawm wrp@dhcs.ca.gov thiab suav nrog "Missing Application Link" hauv kab ntawv.
Tej yam uas yuav tsum paub ua ntej koj pib:
Khaws koj tus browser qhib kom txog thaum koj tau ua tiav kev sau npe. Kaw koj tus browser ua ntej ua tiav yuav xav kom koj pib sau npe txij thaum pib.
Koj yuav tsum nyem 'Next' ntawm nplooj ntawv feem ntau mus txuas ntxiv mus rau nplooj ntawv tom ntej.
Koj tuaj yeem rov qab mus rau nplooj ntawv dhau los los ntawm nias 'Prev'.
Txhawm rau pib txheej txheem sau npe, koj yuav tsum lees txais Cov Lus Qhia Tshaj Tawm thiab Tsis Pub Leej Twg Paub hauv qab no ua ntej pib ua haujlwm.
Kev nthuav tawm ntawm Tus Kheej Cov Ntaub Ntawv. Txhawm rau kom lees paub tus kheej thiab kev tsim nyog rau kev koom tes hauv WRP, nws yuav tsum tau muab cov ntaub ntawv qhia koj muab rau cov chaw tso cai hauv xeev / tsoomfwv lossis cov neeg muag khoom thib peb. Thaum nws yog koj qhov kev xaiv ua kom tiav cov ntawv sau npe thiab daim ntawv thov, tsis ua tiav tag nrho cov txheej txheem yuav ua rau tsis muaj peev xwm txiav txim siab txog kev tsim nyog thiab ua kom them nyiaj khaws cia.
Daim ntawv ceeb toom tsis pub twg paub, Civ. Code Tshooj 1798.17: Cov ntaub ntawv ntiag tug uas sau rau hauv thiab nrog daim foos no yog tsis pub lwm tus paub, raws li Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Kev Pabcuam (DHCS) Daim Ntawv Ceeb Toom Txog Kev Tiv Thaiv Tus Kheej uas tuaj yeem pom ntawm no: https://www.dhcs.ca.gov/formsandpubs/laws/priv/Documents/Notice-of-Privacy-Practices-English.pdf. DHCS xav kom cov ntaub ntawv los tswj WRP. DHCS yuav tsis siv lossis qhia cov ntaub ntawv rau lwm lub hom phiaj tshwj tsis yog koj tso cai lossis raws li txoj cai tso cai. Koj yuav tsum muab tag nrho cov ntaub ntawv thov hauv daim foos no. Yog tias koj tsis muab tag nrho cov ntaub ntawv thov, peb yuav tsis tuaj yeem txiav txim siab seb koj puas tsim nyog tau txais kev them nyiaj. Feem ntau, cov neeg uas cov ntaub ntawv no hais txog muaj cai nkag mus rau nws. DHCS tau tso cai los sau cov ntaub ntawv no raws li Txoj Cai Ua Haujlwm 1492. Daim ntawv ceeb toom kev ceev ntiag tug no yog xav tau los ntawm California Civil Code Section 1798.17.
Kuv nkag siab thiab pom zoo tias tag nrho cov ntaub ntawv uas tau muab rau hauv WRP - Covered Entity and Covered Services Employers Registration Form tuaj yeem muab sib qhia.
- Txhawm rau ua kom tiav cov ntawv sau npe, koj yuav raug nug kom paub meej cov ntaub ntawv koj tau nkag mus thiab tso cai rau kev lees paub los ntawm kev nkag mus rau koj thawj thiab lub xeem thiab koj lub npe hauv lub koom haum, thiab tom qab ntawd nyem lub pob ua tiav. Cov lus teb ua tiav tiav yuav muab nrog cov lus qhia ntxiv.
Kuv tshaj tawm nyob rau hauv lub txim txhaum cai raws li txoj cai ntawm lub Xeev California hais tias cov ntaub ntawv yav dhau los nyob rau hauv daim ntawv no thiab tej ntaub ntawv txuas yog muaj tseeb, yog, thiab ua kom tiav raws li qhov zoo tshaj plaws ntawm kuv txoj kev paub thiab kev ntseeg. Kuv raug tso cai xa cov ntaub ntawv no sawv cev ntawm tus neeg thov. Kuv nkag siab los ntawm kev ntaus thawj lub npe thiab lub xeem nyob rau hauv lub thawv hauv qab no suav nrog kuv kos npe hauv hluav taws xob.
Nco tseg: Tus neeg ua pov thawj pom zoo yuav tsum yog tus tswv cuab, tus khub, tus neeg ua haujlwm, lossis tus neeg sawv cev ntawm lub koomhaum / lub koom haum uas muaj txoj cai los khi tus neeg thov.
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Tom qab kev tso npe tso npe, CEs, CSEs, thiab PGEs yuav tau txais email los ntawm DHCS lees paub tias lawv cov ntawv sau npe tau txais lossis xav tau cov ntaub ntawv ntxiv.
Xaiv koj hom chaw:
Cov ntaub ntawv xav tau ntawm daim ntawv sau npe yog nyob ntawm hom chaw. Nco ntsoov xaiv hom chaw uas zoo tshaj plaws qhia txog koj lub koom haum. Yog tias koj muaj ntau tshaj ib lub koom haum uas tau piav qhia hauv qab no nrog tib lub Npe, Tus Naj Npawb Ua Se (TIN), lossis Tsoom Fwv Teb Chaws Tus Neeg Ua Haujlwm Tus Naj Npawb (FEIN), xaiv hom chaw nrog cov neeg ua haujlwm loj tshaj plaws.
Tus Kws Kho Mob - Tus kws kho mob ywj pheej lossis pab pawg kws kho mob. Ib lub koom haum raug cai uas tau cog lus nrog lub chaw tsim nyog los muab cov kev pabcuam kws kho mob, suav nrog, tab sis tsis txwv rau, cov koom haum kho mob thiab cov kws kho mob ib leeg / tib tus tswv.
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Kev Pabcuam Tswvcuab - Ib tus neeg lossis ib lub koomhaum uas ncaj qha ua haujlwm lossis ua haujlwm tswj hwm cov nyiaj ua haujlwm, sijhawm, lossis kev ua haujlwm ntawm ib tus neeg twg; thiab muab cov kev pabcuam hauv chaw, xws li cov neeg ua haujlwm saib xyuas, noj zaub mov, kev pabcuam ib puag ncig, ntxhua khaub ncaws, kev ruaj ntseg, engineering, chaw tswj xyuas, kev tswj xyuas, lossis cov neeg ua haujlwm them nqi los ntawm daim ntawv cog lus nrog lub chaw tsim nyog uas tus neeg lossis lub koomhaum yog tus tswv haujlwm ntawm cov ntaub ntawv.
Lus txhais:
Yog tias koj Hom Lub Hom Phiaj yog "Qhov Chaw Tsim Nyog"
Koj yuav tsum xaiv ib qho ntawm cov chaw hauv qab no:
Lwm Cov Lus Nug Txog Cov Ntawv Sau Npe tau txhais
Tus neeg hu xov tooj (siv rau Lub Npe Hu, Hu rau email chaw nyob, thiab tus xov tooj hu)
| Tus neeg tiv tauj yuav tsum yog tus neeg uas DHCS tuaj yeem tiv tauj, yog tias xav tau, hais txog koj daim ntawv sau npe.
Qhov chaw nyob email yuav raug siv rau tag nrho DHCS cov ntawv xov xwm hais txog koj qhov xwm txheej sau npe thiab cov kauj ruam tom ntej suav nrog daim ntawv thov.
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| NPI | Tus Neeg Muab Kev Pabcuam Hauv Tebchaws: tus lej cim 10 tus lej tshwj xeeb tshaj tawm rau cov kws kho mob hauv Tebchaws Meskas los ntawm Lub Chaw Pabcuam Medicare & Medicaid (CMS). |
| Facility License Number | Tus lej 9 tus lej raug muab los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CDPH). |
| California Medical License Number | Tus lej txheeb xyuas uas cuam tshuam nrog daim ntawv tso cai ua haujlwm uas tso cai rau tus neeg siv tshuaj raws cai raws li tau tshaj tawm los ntawm Medical Board of California. |
| Lag luam daim ntawv tso cai Number | Tus lej cim uas cuam tshuam nrog daim ntawv tso cai uas tso cai rau koj ua lag luam. |
| TIN/FEIN | Tus Naj Npawb Se (Tax Identification Number) lossis Tsoom Fwv Teb Chaws Tus Neeg Ua Hauj Lwm Tus Naj Npawb: tus lej tseem ceeb uas tshwm sim hauv koj daim ntawv W-9. |
Hom Neeg Them Nyiaj (raws li txhais los ntawm Xeev California - Department of Finance) |
Tus Tswv Tus Tswv/Tus Kheej: Tus Kheej * Tus Tswv Cuab * Tus Muab Tswv Yim (Rov Rov Qab Nyob) Kev ntseeg tsis saib xyuas rau tsoomfwv cov hom phiaj se.
Ib Leeg Tswvcuab LLC - muaj los ntawm ib tus neeg: Lub Tuam Txhab Limited Liability (LLC) muaj los ntawm ib tus neeg thiab tsis saib xyuas rau tsoomfwv cov hom phiaj ua se.
Kev Sib Koom Tes: Kev Sib Koom Tes * Kev Koom Tes Tsis Muaj Cai Lij Choj (LLP) * thiab, LLC raug kho raws li Kev Koom Tes.
Vaj tse los yog Trust: vaj tse * Trust (lwm yam tsis suav nrog Grantor Trust).
Corporation - Kev Kho Mob: Corporation uas yog kev kho mob hauv qhov xwm txheej (xws li, kev kho mob thiab kev kho mob, kev kho mob kws kho mob, kev zov me nyuam, kev kho hniav, thiab lwm yam) * LLC uas yuav tsum tau them se zoo li lub tuam txhab thiab yog kev kho mob hauv xwm.
Corporation - Legal: Corporation uas yog kev cai lij choj nyob rau hauv cov xwm txheej (xws li, cov kev pabcuam ntawm kws lij choj, kws txiav txim plaub ntug, cov ntaub ntawv pov thawj muaj feem cuam tshuam txog kev cai lij choj lossis kev cai lij choj, thiab lwm yam) * LLC uas yuav tsum tau them se zoo li lub tuam txhab thiab raug cai hauv xwm.
Corporation - Exempt: Lub tuam txhab uas tsim nyog tau txais kev zam txim, suav nrog 501(c) 3 thiab cov tuam txhab tsis muaj txiaj ntsig hauv tsev.
Corporation - Tag Nrho Lwm Tus: Lub tuam txhab uas tsis ua tau raws li qhov tsim nyog ntawm ib qho ntawm lwm lub tuam txhab cov npe teev saum toj no * LLC uas yuav tsum tau them se raws li lub tuam txhab thiab tsis ua raws li lwm hom kev lag luam uas tau teev tseg saum toj no. |
Tus neeg txais nyiaj nyob hauv Status |
California Cov Neeg Nyob: Tsim nyog los ua lag luam hauv California lossis tuav lub chaw lag luam mus tas li hauv California.
California Nonresident: Koj raug suav hais tias yog neeg tsis nyob hauv yog tias koj qhov chaw ua lag luam mus tas li yog sab nraum California. Kev them nyiaj rau cov neeg tsis nyob hauv tsev rau cov kev pabcuam yuav raug txiav se tawm hauv lub xeev. |
Yog xav paub ntxiv, thov mus saib hauv Tsev Kho Mob thiab Cov Kws Kho Mob Kws Kho Mob COVID-19 Cov Neeg Ua Haujlwm Retention Payments lub vev xaib thiab tshuaj xyuas cov lus nug uas nquag nug (FAQs) thiab cov ntsiab lus ntawm cov ntsiab lus.
Daim ntawv ntxiv: Cov ntaub ntawv xav tau
Cov ntaub ntawv hauv qab no yuav tsum muaj nyob rau hauv daim ntawv sau npe.
Covered Entities (Qualifying Facilities):
- Hom chaw
- Lub npe chaw ua haujlwm lossis lub lag luam / lub npe raug cai cuam tshuam nrog Tus Naj Npawb Tus Neeg Them Se (TIN) / Tsoom Fwv Teb Chaws Tus Zauv Npe (FEIN) (raws li nws tshwm sim hauv daim ntawv IRS W9)*
- Chaw nyob (raws li nws tshwm sim hauv IRS daim ntawv W9)*
- Daim ntawv tso cai tus naj npawb (CDPH muab 9 tus lej) *
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- National Provider Identification (NPI) tus lej
- Cov npe ntawm cov kev cog lus Covered Services Cov tswv hauj lwm muab cov kev pab cuam nyob rau hauv
- Cov npe ntawm cov kws kho mob koom nrog cov chaw muab kev pabcuam hauv chaw
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus Neeg Sau Npe thiab Lub Npe
* Cov teb no yuav cia li populate nrog cov ntaub ntawv preset hauv cov ntawv qhia zaub mov. Txhawm rau muab cov ntaub ntawv manually, xaiv thawj qhov kev xaiv hauv qhov poob.
Cov neeg ua haujlwm tau txais kev pabcuam:
- Lub npe (thawj thiab xeem) lossis lag luam / npe raug cai cuam tshuam nrog TIN / FEIN (raws li nws tshwm hauv IRS daim ntawv W9)
- Chaw nyob (raws li nws tshwm sim ntawm IRS daim ntawv W9)
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- Cov npe ntawm cov chaw tsim nyog tau txais kev pab nyob rau ntawm qhov chaw (cov chaw kho mob uas koj tau cog lus nrog thiab ua tau raws li qhov yuav tsum tau hais hauv FAQs) thiab hom kev pabcuam muab rau ntawm qhov chaw nyob.
- Kev xa tawm digital ntawm feem cuam tshuam ntawm daim ntawv cog lus cog lus nrog Cov Koom Haum Pabcuam, suav nrog kev ua haujlwm thiab nplooj ntawv kos npe
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus kws kho mob lub npe thiab lub npe
Cov Kws Kho Mob Pab Pawg (lossis Cov Kws Kho Mob ywj pheej):
- Tus kws kho mob lub npe (thawj thiab xeem) lossis lub lag luam / lub npe raug cai cuam tshuam nrog TIN / FEIN (raws li nws tshwm sim hauv IRS daim ntawv W9)
- Chaw nyob (raws li nws tshwm sim ntawm IRS daim ntawv W9)
- TIN los yog FEIN
- Hom neeg them nyiaj
- Tus neeg txais nyiaj nyob hauv xeev (California neeg nyob lossis California tsis nyob hauv)
- Lub npe hu (thawj thiab xeem)
- Hu rau email chaw nyob thiab xov tooj
- Kwv yees tus naj npawb ntawm cov neeg ua haujlwm tsim nyog
- NPI num
- Tus kws kho mob / tus lej ntawv tso cai kho mob (npe daim ntawv tso cai ua lag luam hauv California, yog tias tus kheej)
- Cov npe ntawm cov chaw tsim nyog uas tau muab kev pabcuam
- Ua tiav daim ntawv STD 204 (Payee Data Record).
- Tus kws kho mob lub npe thiab lub npe
