Portable Imaging Provider Application Information
Portable Imaging Provider Application Information
Portable Imaging Providers yuav tsum xa daim ntawv thov los ntawm PAVE (Kev Pabcuam Daim Ntawv Thov Kev Pabcuam thiab Kev Pov Hwm rau Kev Sau Npe).
PED thov kom koj xa daim ntawv npog nrog koj daim ntawv thov PAVE teev cov hom khoom siv duab, CPT Codes koj npaj siab yuav sau nqi rau, cov npe ntawm cov kws tshaj lij muab cov kev pabcuam kev pabcuam thiab cov npe ntawm cov kws kho mob muab cov npe. kev ua haujlwm feem ntawm cov kev pabcuam.
Tus nqi thov
Pib txij Lub Ib Hlis Ntuj Tim 1, 2013, cov neeg thov kev tso npe thov kev tso npe ua Tus Muab Kev Pom Zoo Portable yuav raug them tus nqi ntawm daim ntawv thov thaum xa lawv daim ntawv thov. Daim Ntawv Thov Medi-Cal Cov Nqi Them Rau Kev Ua Raws Li Txoj Cai 42 Txoj Cai ntawm Tsoom Fwv Teb Chaws Txoj Cai Tshooj 455.460Kev Cai Lub Chaw Pabcuam Tshaj Tawm muab cov ntaub ntawv tshwj xeeb hais txog qhov yuav tsum tau ua no. Yog xav paub txog tus nqi ntawm daim ntawv thov tam sim no, thov mus saib Cov Chaw Pabcuam ntawm Medi-Cal Cov Chaw Pabcuam Sau Npe Nkag mus rau nplooj ntawv.
Daim ntawv pov thawj ntawm kev sau npe
Prior to applying to Medi-Cal, first check with the California Department of Public Health’s Radiologic Health Branch and click on “Programs”, then “Food, Drug and Radiation Safety” then “Radiologic Health Branch” and ensure you meet all the certification, registration and permit requirements.
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.
- RHB Radiation Tshuab Kev Sau Npe thiab/lossis Mammography Tshuab Certification; California Radiology Supervisor Operator Permit(s), Radiologic Technologist Certificate(s) and/or X-Ray Technologist Permit(s) and/or Mammographic Radiologic Technologist Certificate(s), raws li muaj; California Medical License tam sim no rau tus kws kho mob saib xyuas. Tag nrho lwm cov ntawv pov thawj kho mob thiab cov ntawv sau npe raws li qhov yuav tsum tau ua raws li hom khoom siv.
- 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. 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.
- Federal Employer Identification Number (FEIN) los yog Individual Taxpayer Identification Number (ITIN) verification, yog tsis siv tus social security naj npawb, xa mus rau tam sim no Internal Revenue Service (IRS) generated document. 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.
- 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 select the “California’s Counties” link, then select “County Web Sites.”
- 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.”
- Tam sim no Commercial Vehicle Registration thiab pov thawj ntawm Commercial Vehicle Insurance tam sim no.
- 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:
- Rau Kev Koom Tes Sib Koom Tes, ib daim ntawv teev npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj kev txaus siab rau txhua tus; los yog
- Rau Kev Koom Tes Ua Lag Luam Limited, cov ntaub ntawv txheeb xyuas Tus Neeg Koom Tes General thiab cov npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj cov paj laum rau txhua tus.
- To verify or change the name and/or status of your partnership 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.
- If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation from the California Secretary of State (or a Statement of Domestic Stock Corporation if your corporation is based outside of California), 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 Portal and click on the “California Business Search” link or other appropriate link.
- 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 nkaus txhua xyoo 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.
- 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 rau txhua tus neeg muaj ntawv tso cai teev nyob rau hauv daim ntawv thov pob. 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 pom nyob rau hauv daim ntawv tso cai tus kws tshaj lij (s) daim ntawv tso cai yuav tsum tau qhia nyob rau hauv kev txheeb xyuas ntawm daim ntawv pov hwm kev lav phib xaub.
- 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.
- Daim ntawv cog lus tam sim no ntawm tus kws kho mob thiab tus kws kho mob saib xyuas, yog tias muaj.
- Successor Liability with Joint and Several Liability Agreement (DHCS 6217), yog muaj.
PAUB Portal
Nkag mus rau PAVE portal.