Cov Ntaub Ntawv Thov Kev Pab Kho Mob
Doctors of Medicine are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment). If you are submitting a group application, please ensure you also submit at least two rendering applications in PAVE in order to form your group.
Cov kws kho mob ntawm cov tshuaj, kws kho mob osteopathy, kws kho mob pab thiab cov kws kho mob tuaj yeem koom ua ke hauv pab pawg kho mob rau kev tso npe kawm; Cov kws kho mob uas tau tso npe tshuaj loog tuaj yeem tso npe rau hauv pab pawg kws kho mob tshwj xeeb hauv tshuaj loog; Cov niam txiv uas muaj ntawv tso cai thiab cov kws saib xyuas neeg mob muaj ntawv pov thawj tuaj yeem tso npe rau hauv pab pawg kws kho mob tshwj xeeb hauv kev yug menyuam.
Yog tias koj qhov kev kho mob raws li nyob rau hauv ib lossis ntau lub tsev kho mob mob hnyav, cov tsev kho mob nyob deb nroog, lossis lub tsev kho mob puas siab puas ntsws, saib cov lus qhia hauv Tsev Kho Mob-Based Physician.
Physicians who are board-certified in Clinical Genetics may apply for, and receive, a separate category of service (COS) for reimbursement for genetic services. In order to add this category of service, please submit a Medi-Cal Supplemental Changes Form (DHCS 6209) to DHCS PED as this cannot be completed in PAVE.
Daim ntawv tso cai
Ua ntej thov rau Medi-Cal, ua ntej mus xyuas Pawg Saib Xyuas Kev Kho Mob ntawm California kom ntseeg tau tias koj ua tau raws li tag nrho cov 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.
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Tam sim no California Daim Ntawv Tso Cai Kho Mob ntawm tus neeg thov lossis tus kws kho mob. Thov suav nrog Daim Ntawv Tso Cai Tso Tshuaj Txhaum Cai, Daim Ntawv Tso Cai Tsis Txaus Siab thiab / lossis DEA Daim Ntawv Pov Thawj, yog tias muaj.
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Daim Ntawv Tso Cai Tsav Tsheb lossis daim npav qhia tawm hauv lub xeev (tso tawm nyob rau hauv 50 Tebchaws Meskas lossis Cheeb Tsam ntawm Columbia) ntawm tus kws kho mob, lossis tus neeg kos npe rau daim ntawv thov uas muaj txoj cai khi rau tus neeg thov lossis tus 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, tsoomfwv lossis lub koomhaum tsis muaj txiaj ntsig. Yog tias tus neeg muab kev pabcuam yog ib qho ntawm peb lub koomhaum no thiab daim ntawv thov yuav raug kos npe los ntawm ib tus neeg tsis yog tus muab kev pabcuam, thov xa cov ntaub ntawv uas qhia txog tus neeg kos npe txoj cai rau kev cai lij choj khi rau lub koomhaum lossis lub koomhaum tsis muaj txiaj ntsig lossis sawv cev rau tsoomfwv lub koomhaum.
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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 tias muaj kev pabcuam hauv chaw kuaj mob. Yog xav paub ntxiv, mus saib Lub Chaw Pabcuam Medicare thiab Medicaid
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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.
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State Clinical Laboratory License/Registration, los yog kev pov thawj ntawm kev zam los ntawm daim ntawv tso cai / sau npe, yog tias muaj kev pabcuam hauv chaw kuaj mob. 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.
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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 (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 select the “California’s Counties” link, then select “County Web Sites.”
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Fictitious Name Permit (FNP) issued by the Medical Board of California, if using a fictitious name for your medical practice, as defined by the Board. Note: The business name of the applicant or provider on the application, all local business licenses/permits, and the FNP must exactly match. For further information, visit the Medical Board and click on the “Licensee” tab, then the “Fictitious Name Permit” link.
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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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To verify or change the name and/or status of your partnership 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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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 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. ** Yog tias qhov chaw nyob ua lag luam ntawm daim ntawv thov raug txheeb xyuas tias yog lub chaw kho mob muaj ntawv tso cai, thiab tus kws kho mob xa tag nrho cov kev pabcuam hauv lub chaw kho mob muaj ntawv tso cai no, tus kws kho mob raug zam los ntawm kev tau txais kev pov hwm kev lag luam. Yog tias cov kev pabcuam raug muab tso rau ntawm ntau tshaj ib lub tsev kho mob uas muaj ntawv tso cai, thov muab cov npe ntawm txhua lub tsev kho mob npe thiab chaw nyob ua lag luam.
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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 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.
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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.
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If you are enrolling as a Clinic-Based Provider, Facility-Based Provider, or Preferred Provider, please ensure you meet the other specific enrollment requirements and submit all additional required documentation. For further information, visit the Medi-Cal site and click on the “Provider Enrollment” link, and then “Statutes, Regulations and Provider Bulletins.”
PAUB Portal
Proceed to the PAVE portal.