Independent Diagnostic Testing Facility Application Information
Raws li Txoj Cai 42, CFR, Tshooj 410.33, Lub Chaw rau Medicare thiab Medicaid Services, thiab State Medicaid Phau Ntawv Qhia, Tshooj 3490 txog 3490.14, Cov chaw kuaj mob ywj pheej (IDTF) tsuas yog tsim nyog rau npe rau hauv Medi-Cal qhov kev pab cuam raws li "Medicare Crossover nkaus xwb" cov kws kho mob txhawm rau tau txais cov nyiaj them rov qab rau Medicare Part B cov kev pabcuam.
1. Federal Employer Identification Number (FEIN) los yog Tus Naj Npawb Tus Neeg Them Se (ITIN) , yog tsis siv tus lej social security, los ntawm kev xa daim ntawv tam sim no Internal Revenue Service (IRS) generated. Tsuas yog cov ntaub ntawv lees paub muaj xws li IRS-tsim Tsab Ntawv 147-C, IRS-tsim Daim Ntawv 941 (Tsuas Ua Haujlwm Lub Peb Hlis Federal Tax Return), IRS-tsim Daim Ntawv Foos 8109-C (Daim Coupon Deposit), lossis IRS-tsim Daim Ntawv SS-4 (tsuas yog Daim Ntawv Pom Zoo/Kev Qhia Txog Tus Kheej). Nco tseg: Lub npe raug cai ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum ua raws nraim lub npe ntawm IRS-tsim cov ntaub ntawv; thiab tus neeg thov kev pab yuav tsum yog tus tswv lossis tus tub ceev xwm ntawm lub chaw teev npe hauv daim ntawv IRS. Yog xav paub ntxiv, thov mus ntsib IRS lossis hu rau lawv ntawm (800) 829-4933.
2. Daim ntawv pov thawj pom zoo raws li Kev Tshawb Fawb Kev Tshawb Fawb Independent Diagnostic Testing Facility (IDTF) los ntawm Lub Chaw Pabcuam Medicare thiab Medicaid (CMS).
TUAJ RAU PAB
