Hla mus rau Cov Ntsiab Lus Tseem Ceeb

Daim Ntawv Qhia Tshuaj Kho Mob Medi-Cal

MC 5120AD - Tus neeg muag khoom pom zoo daim ntawv pov thawj (PDF)
MC 5121AD - County-Direct Provider Approver Certification (PDF)
MC 5123AD - DHCS Cov Neeg Ua Haujlwm Pom Zoo Ntawv Pov Thawj (PDF)
MC 5131AD - County-Direct Provider User Cancellation (PDF)
DHCS 5311 Daim Ntawv Thov Kev Thov: Tshuaj Medi-Cal (DMC) Kev Thov Kev Them Nyiaj Rov Qab Los ntawm Kev Pov Hwm Zoo - Kev Siv Nyiaj Rov Qab (QA/UR) Tus Nqi (PDF)

Hu rau BHFSOps@dhcs.ca.gov inbox rau daim ntawv thov ua haujlwm uas nrog rau daim ntawv thov kev lees paub no.

DHCS 5312 Daim Ntawv Qhia Txog Kev Thov: Tshuaj Medi-Cal (DMC) Cov Kev Pabcuam Thov rau Kev Them Nyiaj Rov Los Ntawm Lub Nroog Tus Nqi Se (PDF)

Hu rau SUDFMAB@dhcs.ca.gov inbox rau daim ntawv thov kev pab uas nrog rau daim ntawv thov kev pab no.

DHCS 6065A Daim Ntawv - Daim Ntawv Pov Thawj Zoo (PDF)
DHCS 6065A Cov Lus Qhia - Daim Ntawv Pov Thawj Zoo (PDF)
DHCS 6065B Daim Ntawv Pov Thawj Zoo (PDF)
DHCS 6065B Cov Lus Qhia - Daim Ntawv Pov Thawj Zoo (PDF)
DHCS 6700 Daim Ntawv Qhia - Daim Ntawv Pov Thawj Ua Haujlwm Ntau Yam (PDF)
DHCS 6700 Cov Lus Qhia - Ntau Cov Lus Qhia Txog Kev Sau Npe Pov Thawj (PDF)
DHCS 100185 Form - DMC Claim Submission Certification - Direct Contract Provider (PDF)
DHCS 100185 Cov Lus Qhia - DMC Daim Ntawv Tso Cai Xa Ntawv Pov Thawj - Tus Muab Daim Ntawv Cog Lus Ncaj Ncees (PDF)
DHCS 100186 Form - DMC Claim Submission Certification - County Contracted Provider (PDF)
DHCS 100186 Instructions - DMC Claim Submission Certification - County Contracted Provider (PDF)
DHCS 100187 Form - DMC Claim Submission Certification - County Operated Provider Form (PDF)
DHCS 100224 - Tshuaj Medi-Cal Certification rau Tsoom Fwv Teb Chaws Nyiaj Them Nqi (PDF) - Kho 04/2025
DHCS 8049 Form - Lub Nroog Certification of Compliance (PDF) - Kho 04/2024
DHCS 8049 Cov Lus Qhia - Lub Nroog Certification of Compliance (PDF)
DHCS 5260 Form - SUDCRS Daim Ntawv Pom Zoo (PDF)

Hnub hloov tshiab kawg: 10/17/2025 1:44 PM