Cov Ntaub Ntawv Thov Kev Pabcuam Pab Pawg
Ib pab pawg neeg muab kev pab txhais tau tias yog ob lossis ntau dua cov neeg muab kev pabcuam ua lag luam ua ke nyob rau hauv ib pawg neeg muab kev pabcuam ntawm tib qhov chaw nyob ua lag luam. Thaum ua ntawv thov ua pab pawg, ntxiv rau daim ntawv thov pab pawg, yuav tsum xa daim ntawv thov ua tiav rau txhua tus kws kho mob uas tsis tau teev npe hauv Medi-Cal uas tab tom muab kev pabcuam rau pab pawg.
Pawg neeg muab kev pabcuam yuav tsum xa lawv daim ntawv thov tus kheej thiab/lossis pab pawg los ntawm Kev Pabcuam Kev Pabcuam thiab Kev lees paub rau Kev Sau Npe (PAVE). Yog tias koj tab tom xa ib daim ntawv thov pab pawg, thov xyuas kom koj xa tsawg kawg ob daim ntawv thov kev ua haujlwm hauv PAVE txhawm rau tsim koj pab pawg.
Daim ntawv tso cai
Ua ntej ua ntawv thov rau Medi-Cal, ua ntej kos daim ntawv tso cai yuav tsum muaj nyob rau ntawm daim ntawv tso cai lub vev xaib uas siv rau koj hom kws kho mob.
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.
1. Fictitious Name Permit (FNP) if required by your licensing board and/or Fictitious Business Name Statement (FBNS), issued by the county where the business is located, if using a fictitious name. In the case of a corporation, any fictitious business name other than the corporation name on record with the Secretary of State requires a FBNS. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
2. Clinical Laboratory Improvement Amendment (CLIA) Daim Ntawv Pov Thawj (txhua nplooj ntawv), tsim nyog rau qib kev sim ua, yog tias muaj kev pabcuam hauv chaw kuaj mob ntawm koj lub hoobkas. Yog xav paub ntxiv, mus saib hauv Lub Chaw rau Medicare thiab Medicaid Cov Kev Pab CuamCeeb Toom: 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.
3. S tate 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.
Note: The name and business address of the applicant or provider on the application, the CLIA Certificate, and the State Clinical Laboratory License/Registration (or exemption) must exactly match.
4. 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 pawg 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, 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.
5.Federal Employer Identification Number (FEIN) los yog Individual Taxpayer Identification Number (ITIN) pov thawj, 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.
6. 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 and click on the “California’s Counties” link, and select “County Web Sites.”
7. Daim Ntawv Tso Cai Muag Khoom uas tau muab los ntawm California State Board of Equalization, yog muaj. 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.
8. Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number, if applicable, of the applicant or provider on all forms must exactly match the insured’s name and address on the certificate of insurance or declaration sheet.
9. 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 tsawg kawg nkaus txhua xyoo tag nrho 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: Cov pab pawg neeg muab kev pab lub npe, raws li nws tshwm nyob rau hauv FNP lossis FBNS, California Clinical Laboratory License, thiab cov ntawv tso cai ua haujlwm, yuav tsum phim lub npe ntawm kev txheeb xyuas cov ntawv pov hwm kev lav phib xaub rau pab pawg.
10. 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.
11. Kos Npe Daim Ntawv Pom Zoo, yog tias lub 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 pab pawg 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.
12. Ua tiav Daim Ntawv Pom Zoo Koom Tes Ua Haujlwm, 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:
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
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.
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.
13. Yog tias koj lub lag luam yog ib lub tuam txhab, kev ua haujlwm qeeb yuav raug zam los ntawm kev xa ib daim ntawv luam ntawm Cov Ntawv Teev Npe ntawm Kev Koom Tes ntawm Lub Xeev, thiab cov npe ntawm cov thawj coj thiab cov tub ceev xwm cov npe thiab cov npe, nrog rau feem pua ntawm cov tswv cuab thiab tswj kev txaus siab rau txhua tus. .
To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
14. Kev lav phib xaub ua tiav nrog Daim Ntawv Pom Zoo Sib Koom thiab Ntau Qhov Kev Pom Zoo (DHCS 6217), yog tias muaj.
15. If you are enrolling as a Facility-Based Provider Group, please ensure you meet the other specific enrollment requirements and submit all additional required documentation. For further information, visit the Medi-Cal and click on the “Provider Enrollment” link, and then “Statutes, Regulations and Provider Bulletins.”