Clinical Laboratory Application Information
Clinical Laboratories are required to submit their application via PAVE (Provider Application and Validation for Enrollment).
Daim ntawv tso cai thiab ntawv pov thawj
Prior to applying to Medi-Cal, you must have obtained a California Clinical Lab License or Registration to accompany your Clinical Laboratory Improvement Amendment (CLIA). Check with the California Department of Public Health, Lab Field Services Branch at (510) 620-3800 to verify that you meet all of the licensing requirements.
Tus nqi thov
Effective January 1, 2013, applicants requesting enrollment as a Clinical Laboratory Provider are subject to payment of an application fee upon submission of their application. The Medi-Cal Application Fee Requirements for Compliance with 42 Code of Federal Regulations Section 455.460Regulatory Provider Bulletin offers specific information regarding this requirement. For current application fee information, please see the Current Application Fee document/page.
Cov ntaub ntawv xav tau
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Daim Ntawv Tso Cai Tsav Tsheb lossis daim npav qhia tawm hauv lub xeev (tso tawm hauv 50 Tebchaws Meskas lossis Cheeb Tsam ntawm Columbia) ntawm tus neeg muab kev pabcuam, lossis tus neeg kos npe rau daim ntawv thov uas muaj txoj cai khi rau tus neeg thov lossis tus neeg muab kev pabcuam. Daim ntawv kos npe yuav tsum yog tus muab kev pabcuam, tshwj tsis yog tus neeg muab kev pabcuam yog lub koomhaum. Yog tias tus kws kho mob yog ib lub tuam txhab thiab daim ntawv thov yuav raug kos npe los ntawm ib tus neeg uas tsis yog tus muab kev pabcuam, thov xa ib daim ntawv theej ntawm ntu ntawm lub tuam txhab txoj cai lij choj uas txheeb xyuas tus neeg kos npe txoj cai rau kev cai lij choj lub koom haum.
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Federal Employer Identification Number (FEIN) los yog Individual Taxpayer Identification Number (ITIN) verification, yog tsis siv tus social security naj npawb, los ntawm kev xa ib 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 xyuas nrog IRS lossis hu rau lawv ntawm (800) 829-4933.
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Clinical Laboratory Improvement Amendment (CLIA) Certificate (txhua nplooj ntawv), tsim nyog rau qib kev sim ua. Yog xav paub ntxiv, mus saib hauv Lub Chaw rau Medicare thiab Medicaid Services.
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Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov, daim ntawv pov thawj CLIA, thiab Lub Xeev Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv / Kev Sau Npe yuav tsum sib haum. Yog tias koj tab tom muab kev pabcuam hauv tsev kho mob thiab siv tsev kho mob CLIA, suav nrog sau ntawv lees paub los ntawm lub tsev kho mob tias koj raug tso cai siv tsev kho mob CLIA.
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California Clinical Laboratory Licence/Registration, los yog kev pov thawj ntawm kev zam los ntawm daim ntawv tso cai / sau npe. Hu rau lub chaw ua haujlwm Laboratory Field Services ntawm (510) 620-3800 txhawm rau txiav txim siab seb daim foos tshwj xeeb uas koj yuav tsum xa, thiab tom qab ntawd rub tawm cov ntawv no. Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov, daim ntawv pov thawj CLIA, thiab Lub Xeev Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv / Kev Sau Npe (lossis kev zam) yuav tsum sib haum.
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Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties click on the “California’s Counties” link, and select “County Web Sites.”
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Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties click on the “California’s Counties” link, and select “County Web Sites.”
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Daim Ntawv Tso Cai Muag Khoom tau muab los ntawm California State Board of Equalization, yog tias tsim nyog. Nco tseg: Lub npe lag luam thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum phim lub npe lag luam thiab chaw nyob ua lag luam ntawm tus muag daim ntawv tso cai. Yog xav paub ntxiv, mus saib hauv Pawg Neeg Saib Xyuas Kev Ncaj Ncees lossis hu rau lawv ntawm (916) 445-6362.
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Ua tiav Daim Ntawv Pom Zoo Sib Koom Tes, yog tias koj lub lag luam yog kev koom tes. Kev ua haujlwm qeeb yuav raug zam los ntawm kev qhia seb lub koom haum puas yog General Partnership lossis Limited Partnership thiab tseem xa cov hauv qab no:
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a) Rau General Partnership, ib daim ntawv teev npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj cov paj laum rau txhua tus; los yog
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b) Rau Kev Koom Tes Ua Lag Luam Txwv, cov ntaub ntawv txheeb xyuas tus khub General, thiab cov npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj kev txaus siab rau txhua tus.
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Txhawm rau txheeb xyuas lossis hloov lub npe thiab / lossis xwm txheej ntawm koj txoj kev koom tes lossis xav paub ntxiv, thov mus saib Tus Tuav Ntaub Ntawv Hauv Xeev California Kev Lag Luam Portal thiab nyem rau ntawm "California Lag Luam Tshawb Fawb" txuas lossis lwm qhov txuas uas tsim nyog.
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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 and/or status of your corporation or for further information, please visit the Secretary of State California Business and click on the “California Business Search” link or other appropriate link.
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Certificate of Commercial Liability Insurance (kev lag luam, kev lag luam, lossis kev lav phib xaub, lossis kev tuav pov hwm hauv chaw ua haujlwm) hauv tus nqi tsis pub tsawg dua $ 100,000 rau ib daim ntawv thov thiab qhov tsawg kawg ib xyoos ib zaug ntawm $ 300,000. Kev lees paub lees paub yog pov thawj ntawm kev tuav pov hwm tus kheej, lossis 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 thiab chaw nyob ua lag luam ntawm cov ntawv pov hwm, hnub siv tau, thiab kev txwv ntawm kev pov hwm. Nco tseg: Lub npe thiab chaw nyob ua lag luam, suav nrog tus lej suite yog tias tsim nyog, ntawm tus neeg thov lossis tus neeg muab kev pabcuam hauv daim ntawv thov yuav tsum ua raws nraim li tus neeg tuav pov hwm lub npe thiab chaw nyob ntawm daim ntawv pov thawj ntawm kev tuav pov hwm lossis daim ntawv tshaj tawm.
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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 nyob rau hauv California Clinical Laboratory License, yuav tsum tau qhia txog kev txheeb xyuas qhov kev pov hwm kev lav phib xaub.
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Certificate of Workers 'Compensation Insurance yog xav tau los ntawm California txoj cai lij choj, yog tias koj lub lag luam muaj ib lossis ntau tus neeg ua haujlwm. Kev lees paub lees paub yog pov thawj ntawm kev tuav pov hwm tus kheej, lossis 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 thiab chaw nyob ua lag luam ntawm cov ntawv pov hwm, thiab hnub siv tau. Yog tias tsis muaj kev pov hwm them nyiaj rau Cov Neeg Ua Haujlwm, yuav tsum muaj lus piav qhia. Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam yuav tsum ua raws nraim li cov ntawv pov hwm lub npe thiab chaw nyob ntawm daim ntawv pov thawj ntawm kev pov hwm.
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Kos Npe Daim Ntawv Pom Zoo, yog tias thaj chaw lag luam tsis yog los ntawm tus neeg thov lossis tus muab kev pabcuam. Nco tseg: Lub npe thiab chaw nyob ua lag luam ntawm tus neeg thov lossis tus neeg muab kev pabcuam yuav tsum ua raws nraim li tus neeg xauj tsev lub npe thiab chaw nyob ntawm daim ntawv cog lus xauj tsev.
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Successor Liability with Joint and Several Liability Agreement (DHCS 6217), yog muaj.
PAUB Portal
Proceed to the PAVE portal.