Cov Ntaub Ntawv Thov Tus Kws Kho Mob
Cov kws kho mob yuav tsum xa lawv daim ntawv thov tus kheej thiab/lossis pab pawg los ntawm PAVE (Kev Pabcuam Daim Ntawv Thov Kev Pabcuam thiab Kev Pov Hwm rau Kev Sau Npe). Yog tias koj tab tom xa daim ntawv thov pab pawg, thov xyuas kom koj tseem xa tsawg kawg ob daim ntawv thov kev ua haujlwm hauv PAVE.
Daim ntawv tso cai
Ua ntej thov rau Medi-Cal, ua ntej kos nrog California Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv uas tau sau npe kom paub tseeb 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.
1. California Daim Ntawv Tso Cai Saib Xyuas Neeg Mob thiab Daim Ntawv Pov Thawj Tus Kws Kho Mob los ntawm lub koom haum hauv lub tebchaws lossis lub xeev tau lees paub los ntawm California Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv, thiab qhia txog thaj tsam ntawm kev cob qhia tshwj xeeb.
2. Daim ntawv tso cai tsav tsheb lossis daim npav qhia tawm hauv lub xeev (tso tawm hauv 50 Tebchaws Meskas lossis Cheeb Tsam Columbia) rau tus neeg thov.
3. 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: Tus kws kho mob lub npe, raws li nws tshwm nyob rau hauv California Daim Ntawv Tso Cai Saib Xyuas Neeg Mob thiab Daim Ntawv Pov Thawj Tus Kws Kho Mob, yuav tsum tau qhia txog kev txheeb xyuas cov ntawv pov hwm kev lav phib xaub.
4. For ‘individual stand alone enrollment’: Federal Employer Identification Number (FEIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit the IRS or call them at (800) 829-4933.
5. For ‘individual stand alone enrollment’: 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 the application must exactly match the insured’s name and address on the certificate of insurance or declaration sheet.
6. For ‘individual stand alone enrollment’: Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. 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, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name and business address of the applicant or provider must match the insured’s name and address on the certificate of insurance.
7. For ‘individual stand alone enrollment’: Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
8. For ‘individual stand alone enrollment’: 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.”
9. For ‘individual stand alone enrollment’: 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 and click on the “California’s Counties” link, and select “County Web Sites.”
10. For ‘individual stand alone enrollment’ : Yog tias koj lub lag luam yog ib lub tuam txhab, kev ua haujlwm qeeb yuav raug zam los ntawm kev xa cov ntawv luam ntawm Cov Ntawv Sau Npe 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.
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.
11. For ‘individual stand alone enrollment’: If your business is a partnership, a fully executed Partnership Agreement. Processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and also submitting the following:
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.
12. For ‘individual stand alone enrollment’: Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.