Daim ntawv teev npe rau kev sau npe no tsuas yog rau cov Kws Tshawb Fawb Txog Kev Coj Tus Kheej thiab Cov Kws Kho Mob Hlwb Kev Kawm uas tau ntawv pov thawj los pab lawv nrog kev sau npe Medi-Cal ua tus kws muab kev pab QAS. Thov nco ntsoov tias cov kws tshaj lij QAS thiab cov kws pab tswv yim QAS (cov kws kho tshuab) tsis tas yuav thov rau kev sau npe Medi-Cal.​​ 

Ua ntej koj yuav sau npe ua tus kws kho mob QAS (tus kheej lossis lub koom haum) hauv Medi-Cal lub txheej txheem sau npe kws kho mob, thov npaj cov ntaub ntawv, daim ntawv pov thawj thiab daim ntawv tso cai hauv daim ntawv teev npe hauv qab no. Daim ntawv teev npe suav nrog cov kev cai ua lag luam hauv zos lossis xeev ntxiv rau cov kev tsim nyog uas tau teeb tsa los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) los sau npe ua tus kws muab kev pabcuam QAS. Thov saib Cov Lus Nug Feem Ntau Nug Txog Kev Kho Mob Kev Noj Qab Haus Huv rau Cov Kws Muab Kev Pab, Lo Lus Nug No. 3, rau cov ntaub ntawv hais txog kev lees paub txog kev tsim nyog ntawm kev muab cov kws kho mob QAS, cov kws tshaj lij QAS, thiab cov kws pab tswv yim QAS ua ib feem ntawm daim ntawv thov, pib thaum nruab nrab Lub Kaum Ib Hlis, 2025.​​ 

Daim ntawv teev npe no yuav pab koj txiav txim siab seb koj yuav tsum xa cov ntaub ntawv twg ua ib feem ntawm koj daim ntawv thov kev pab kho mob Medi-Cal, nyob ntawm seb koj sau npe li cas thiab koj yuav muab kev pabcuam rau cov tswv cuab Medi-Cal hauv cov nroog twg.​​ 

Cov kws kho mob QAS uas tam sim no muaj txoj hauv kev rau npe, suav nrog cov kws kho mob, cov kws kho mob puas siab puas ntsws, cov kws kho lub cev, cov kws kho mob ua haujlwm, cov kws kho mob sib yuav thiab tsev neeg uas muaj ntawv tso cai, cov neeg ua haujlwm pabcuam hauv tsev kho mob uas muaj ntawv tso cai, cov kws pab tswv yim hauv tsev kho mob uas muaj ntawv tso cai, cov kws kho mob hais lus, thiab cov kws kho mob hnov lus, tsis tas yuav rov qab rau npe ua tus kws kho mob QAS kom them nqi rau cov kev pabcuam BHT. Cov chaw muab kev pab no yuav tsis tas yuav tshaj tawm BCBAs, cov kws tshaj lij QAS, lossis cov kws pab tswv yim QAS.​​ 

Lus Cim: Medi-Cal tam sim no xav kom cov neeg muab kev pab QAS muaj ib qho chaw ua lag luam uas tau tsim tsa (EPOB), raws li ntu 51000.60 ntawm Title 22 ntawm Code of Federal Regulations. DHCS npaj siab yuav tshaj tawm tsab ntawv xov xwm txog kev cai lij choj tom qab xyoo 2025 kom zam qhov kev cai no rau cov BCBA ib leeg uas ua haujlwm sab nraum lawv lub tsev thiab muaj EPOB qhov twg lawv pom cov neeg siv khoom. Cov BCBA ib leeg uas tau cog lus nrog Medi-Cal txoj kev npaj kho mob thiab tsis muaj EPOB tam sim no tsis tas yuav sau npe. DHCS tab tom ua haujlwm los tshaj tawm tsab ntawv xov xwm tshiab txog kev cai lij choj kom zam qhov yuav tsum tau ua EPOB rau cov BCBA ib leeg. Thaum twg luam tawm lawm, cov BCBA ib leeg yuav tsum tau sau npe.​​ 

Section A – Mandatory Documentation​​ 

This section includes all documents that you are required to submit as part of your Medi-Cal provider enrollment application as a QAS provider in Medi-Cal.​​ 

• Daim ntawv luam ntawm Daim Ntawv Tso Cai Tsav Tsheb tam sim no lossis daim ntawv qhia tawm hauv lub xeev rau txhua tus neeg uas muaj 5 feem pua los yog ntau dua cov tswv cuab rau ib tus neeg kos npe rau daim ntawv thov sawv cev ntawm lub koom haum.​​ 
• Document identifying how you operate your business, which includes asole-proprietorship, corporation, Limited Liability Company (LLC) or partnership (See definitions in Appendix A: Definitions)​​ 
• National Provider Identification Number (NPI)​​ 

• • To apply and receive an NPI online, visit the National Plan & Provider Enumeration System website.​​ 
  • Yog tias koj tau tsim ib lub LLC lossis kev koom tes, koj yuav tsum tau txais thiab siv hom 2 NPI rau LLC lossis koom nrog, txawm tias koj yog tus tswv.​​ 

Tshooj B - Cov Ntaub Ntawv Ntxiv Uas Yuav Muaj Tau​​ 

Ntu no suav nrog txhua cov ntaub ntawv uas yuav xav tau raws li cov kev cai ntxiv ntawm lub nroog, lub nroog thiab/lossis lub xeev kom ua lag luam hauv California. Nco ntsoov tias tag nrho cov ntaub ntawv ntxiv no yuav tsis siv rau koj daim ntawv thov, yog li saib xyuas txhua yam kom zoo kom paub tseeb tias koj puas xav tau xa cov ntaub ntawv ntxiv.​​ 

• Workers' Compensation Insurance (Source: Xeev txoj cai)​​ 
  • Cov Nyiaj Pov Hwm Cov Neeg Ua Haujlwm yuav tsum muaj rau qee lub lag luam. Yog tias California txoj cai lij choj hauv xeev xav kom koj lub lag luam kom muaj Nyiaj Pov Hwm Cov Neeg Ua Haujlwm, ces koj yuav tsum xa cov ntaub ntawv pov thawj ntawm kev pov hwm nrog koj daim ntawv thov.​​ 
  • If you are not otherwise required to have Workers’ Compensation insurance, you do not have to obtain insurance to enroll as a Medi-Cal provider.​​ 
  • Yog xav paub ntxiv txog Kev Pov Hwm Rau Cov Neeg Ua Haujlwm, mus saib lub vev xaib Kev Pov Hwm Rau Cov Neeg Ua Haujlwm .​​ 
• Daim ntawv tso cai ua lag luam / Daim ntawv tso cai (Source: City/county rules)​​ 
  • Feem ntau lub nroog xav kom txhua lub lag luam kom tau daim ntawv tso cai ua lag luam. Qhov no muaj tseeb txawm tias kev lag luam yog ua los ntawm ib tus neeg.​​ 
  • Hauv qee lub nroog, daim ntawv tso cai ua lag luam yuav raug hu ua daim ntawv pov thawj se ua lag luam lossis daim ntawv pov thawj kev lag luam.​​ 
  • Yog tias koj tsis tau muaj daim ntawv tso cai ua lag luam, tshuaj xyuas lub vev xaib rau koj lub nroog thiab tau txais daim ntawv tso cai ua lag luam ua ntej xa koj daim ntawv thov.​​ 
  • Yog tias koj lub nroog tsis xav tau daim ntawv tso cai ua lag luam, koj tuaj yeem sau qhov no ntawm koj daim ntawv thov, tab sis nco ntsoov tias feem ntau lub nroog xav tau cov no rau txhua hom kev lag luam.​​ 
  • Yog tias koj tsis nyob hauv qhov txwv ntawm lub nroog koom nrog, koj lub nroog yuav xav tau daim ntawv tso cai ua lag luam. Tshawb xyuas lub vev xaib rau koj lub nroog txhawm rau txheeb xyuas qhov xav tau.​​ 

Lus Cim: Lub npe thiab chaw nyob ntawm daim ntawv tso cai ua lag luam yuav tsum phim lub npe thiab chaw nyob pabcuam uas tau tshaj tawm hauv daim ntawv thov.​​ 

• Lub Npe Lub Npe Ua Lag Luam (FBNS) (Source: Xeev txoj cai)​​ 
  • Qhov yuav tsum tau txais FBNS yog nyob rau hauv lub xeev txoj cai. Txawm li cas los xij, cov txheej txheem kom tau txais FBNS yog los ntawm lub nroog. Yog tias ib tug neeg nyob hauv ib lub nroog thiab xav tau daim ntawv tso cai ua lag luam thiab FBNS, lawv yuav tsum tau txais daim ntawv tso cai ua lag luam los ntawm lub nroog thiab FBNS los ntawm lub nroog.​​ 
  • Koj yuav tsum tau txais FBNS thaum:​​ 
    • Koj tab tom ua haujlwm ua ib tus tswv lag luam thiab siv lub npe rau koj lub lag luam uas tsis suav nrog koj lub xeem.​​ 
    • Koj tab tom ua haujlwm ua LLC lossis koom nrog thiab siv lub npe lag luam uas tsis haum rau lub npe uas tau teev tseg hauv Cov Khoom Siv Khoom Siv lossis Cov Khoom ntawm Lub Koom Haum tau thov rau California Tus Tuav Ntaub Ntawv ntawm Lub Xeev.​​ 
    • Koj tab tom ua haujlwm ua kev koom tes thiab siv lub npe lag luam uas tsis suav nrog lub xeem ntawm txhua tus khub.​​ 
  • Mus saib lub vev xaib rau koj lub nroog kom paub ntau ntxiv thiab cov lus qhia txog kev tau txais FBNS.​​