Clinic-Based Physician Application Instructions and Requirements
Kev tsim nyog
Hom kev sau npe no tsuas yog rau cov kws kho mob uas muab kev pabcuam kho mob ntawm Medi-Cal uas tau sau npe, cov chaw kho mob thawj zaug uas tau tso cai, tsis muaj lwm qhov chaw ua lag luam (piv txwv li chaw ua haujlwm kho mob) uas lawv muab kev pabcuam thiab cov neeg uas xav tau them nqi rau cov kev pabcuam pw hauv tsev kho mob uas tau muab rau cov neeg tau txais txiaj ntsig hauv tsev kho mob dav dav lossis tsev kho mob puas siab puas ntsws. Cov pab pawg tsis tsim nyog rau hom kev sau npe no.
Raws li tsab cai lij choj ntawm Provider Bulletin uas tau luam tawm hauv Medi-Cal Update thaum Lub Kaum Ob Hlis 2005, DHCS tau tsim cov txheej txheem rau kev sau npe ntawm cov kws kho mob uas tsuas yog ua haujlwm los ntawm lossis muab cov kev pabcuam raws li daim ntawv cog lus nrog cov chaw kho mob thawj zaug uas tau tso cai, tshwj tsis yog cov kev pabcuam uas tau muab ua ib feem ntawm qhov kev kawm tiav qib siab txog kev kho mob, thiab cov uas tsis muaj tus lej muab kev pabcuam Medi-Cal uas tau muab rau lawv ib tus zuj zus los them nqi rau cov kev pabcuam kho mob rau cov neeg tau txais Medi-Cal ntawm lwm qhov chaw thiab yog li ntawd, siv lub chaw kho mob thawj zaug uas tau tso cai ua lawv qhov chaw ua haujlwm. Hom kev sau npe no tso cai rau tus kws kho mob sau nqi rau cov kev pabcuam pw hauv tsev kho mob xwb thiab tsis yog rau cov kev pabcuam uas muab rau ntawm Lub Tsev Kho Mob Saib Xyuas Neeg Mob uas Muaj Ntawv Tso Cai. Yuav kom paub tseeb tias koj puas tsim nyog rau hom kev sau npe no, thov nyeem cov ntaub ntawv qhia txog Tus Muab Kev Pabcuam: "Cov Kev Cai thiab Cov Txheej Txheem rau Kev Sau Npe 'Tus Muab Kev Pabcuam Hauv Tsev Kho Mob'".
Yog tias koj tsim nyog rau npe ua Tus Kws Kho Mob Hauv Tsev Kho Mob: Cov Kws Kho Mob Hauv Tsev Kho Mob yuav tsum xa lawv daim ntawv thov tus kheej thiab/lossis daim ntawv thov ua pab pawg los ntawm PAVE (Daim Ntawv Thov thiab Kev Txheeb Xyuas Kev Sau Npe).
Daim ntawv tso cai
Ua ntej koj thov Medi-Cal, ua ntej tshaj, mus saib Medical Board of California lossis Osteopathic Medical Board of California kom paub tseeb tias koj ua tau raws li txhua yam kev cai ntawm daim ntawv tso cai.
Cov ntaub ntawv xav tau
Tom ntej no, sau cov ntaub ntawv xav tau hauv qab no, raws li tsim nyog, txhawm rau muab lawv tso rau hauv PAVE thaum koj ua tiav koj daim ntawv thov PAVE. Thov xyuas kom meej tias cov ntaub ntawv uas tau muab tso tawm yog pom tseeb.
- Daim Ntawv Tso Cai Kho Mob California tam sim no lossis Daim Ntawv Tso Cai Kws Kho Mob Osteopathic thiab Kws Phais Mob ntawm tus neeg thov lossis tus kws kho mob. Thov muab daim ntawv pov thawj DEA, yog tias muaj.
- Daim Ntawv Tso Cai Tsav Tsheb lossis daim npav pov thawj uas lub xeev muab (muab tso rau hauv 50 Tebchaws Meskas lossis Lub Nroog Columbia) ntawm tus neeg muab kev pabcuam uas kos npe rau daim ntawv thov. Daim ntawv kos npe yuav tsum yog tus kws kho mob uas thov.
- Tus lej cim tus tswv haujlwm hauv tsoomfwv (FEIN) lossis tus lej cim tus neeg them se (ITIN) ntawm tus neeg thov kws kho mob, yog tias tsis siv tus lej kev ruaj ntseg hauv zej zog, los ntawm kev xa daim ntawv Internal Revenue Service (IRS) uas tau tsim tam sim no. Cov ntaub ntawv uas siv tau tsuas yog muaj xws li Tsab Ntawv 147-C uas IRS tsim, Daim Ntawv 941 uas IRS tsim (Daim Ntawv Se Rov Qab Los Ntawm Tus Tswv Haujlwm), Daim Ntawv 8109-C (Daim Coupon Tso Nyiaj) uas IRS tsim, lossis Daim Ntawv SS-4 uas IRS tsim (tsuas yog Daim Ntawv Ceeb Toom Txog Kev Muab FEIN/ITIN Ua Haujlwm). Lus Cim: Lub npe raug cai ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum phim lub npe ntawm daim ntawv IRS tsim; thiab tus neeg thov/tus neeg muab kev pabcuam yuav tsum yog tus tswv lossis tus tub ceev xwm ntawm lub koom haum uas teev nyob rau hauv daim ntawv IRS. Yog xav paub ntxiv, thov mus saib IRS lossis hu rau lawv ntawm (800) 829-4933.
- 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.
- Tsab Ntawv Qhia Txog Kev Ua Haujlwm rau Kws Kho Mob (tsawg kawg yog ib tsab) uas muaj cov ntaub ntawv xav tau raws li tau piav qhia nyob rau nplooj ntawv plaub ntawm Daim Ntawv Qhia Txog Kev Muab Kev Pabcuam Hauv Tsev Kho Mob.
- Daim Ntawv Tso Cai Siv Lub Npe Cuav (FNP) uas tau muab los ntawm Pawg Neeg Saib Xyuas Kev Kho Mob ntawm California lossis Pawg Neeg Saib Xyuas Kev Kho Mob Osteopathic ntawm California, yog tias siv lub npe cuav rau koj txoj kev kho mob, raws li tau txhais los ntawm Pawg Neeg Saib Xyuas. Lus Cim: Lub npe lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam rau ntawm daim ntawv thov, txhua daim ntawv tso cai ua lag luam hauv zos, thiab FNP yuav tsum sib xws.
- Yog tias koj lub lag luam yog ib lub koom haum, kev ncua sijhawm ua tiav yuav raug zam los ntawm kev muab daim ntawv theej ntawm Cov Lus Cog Tseg ntawm Lub Koom Haum los ntawm Tus Tuav Ntaub Ntawv ntawm Lub Xeev, thiab daim ntawv teev cov thawj coj thiab cov tub ceev xwm lub npe thiab lub npe, nrog rau feem pua ntawm kev muaj thiab kev tswj hwm rau txhua tus. Txhawm rau txheeb xyuas lossis hloov lub npe lossis txoj cai ntawm koj lub koom haum, lossis kom paub ntxiv, thov mus saib Tus Tuav Ntaub Ntawv ntawm Lub Xeev California Business Portal xaiv qhov txuas "California Business Search" lossis lwm qhov txuas tsim nyog.
- Certificate of Professional Liability Insurance nyob rau hauv ib tug npaum li cas ntawm tsis tsawg tshaj li $100,000 ib daim ntawv thov thiab ib tug yam tsawg kawg nkaus txhua xyoo ntawm $300,000. Kev lees paub lees paub yog daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm uas muab los ntawm lub tuam txhab pov hwm uas muaj lub npe ntawm lub tuam txhab pov hwm, lub npe ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Tus kws kho mob lub npe, raws li nws tshwm sim hauv California Daim Ntawv Tso Cai Kho Mob, yuav tsum tau qhia txog kev txheeb xyuas ntawm kev pov hwm kev lav phib xaub.
PAUB Portal
Mus rau PAVE portal.