자격​​ 

이 등록 유형은 Medi-Cal에 등록되어 면허를 받은 1차 진료 클리닉에서만 의료 서비스를 제공하고 서비스를 제공하는 다른 사업장(예: 진료소)이 없으며 일반 급성 치료 병원 또는 급성 정신 병원 환경에서 수혜자에게 제공한 입원 환자 서비스에 대해 청구해야 하는 개인 의사에게만 해당됩니다. 그룹은 이러한 유형의 등록을 할 수 없습니다.​​ 

Pursuant to the regulatory Provider Bulletin published in the December 2005 Medi-Cal Update, DHCS has established procedures for the enrollment of physicians who are solely employed by or provide services pursuant to a contract with licensed primary care clinics, except for services provided as part of a graduate medical education program, and who do not have any active Medi-Cal provider number issued to them individually to bill for clinical services to Medi-Cal beneficiaries at another location and as such, use the licensed primary care clinic as their established place of business. This type of enrollment allows the physician to bill for inpatient services only and not for services provided at the Licensed Primary Care Clinic. In order to determine whether or not you qualify for this type of enrollment, please read the detailed Provider Bulletin: “Requirements and Procedures for ‘Clinic-Based Provider’ Enrollment”. ​​ 

 

If you qualify to enroll as a Clinic-Based Physician: Clinic-Based Physicians are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment). ​​ 

라이선스​​ 

Prior to applying to Medi-Cal, first check the Medical Board of California or the Osteopathic Medical Board of California to ensure you meet all the licensing requirements.​​       

필수 서류​​ 

그런 다음, 아래에 나열된 필수 서류를 준비하여 해당되는 경우 PAVE 신청서를 작성할 때 PAVE에 업로드하세요. 업로드한 문서가 읽기 쉬운 상태인지 확인하세요.​​ 

• Current California Medical License or Osteopathic Physician and Surgeon’s License of applicant or provider. Please include DEA Certificate, if applicable.​​ 
• Driver’s License or state-issued identification card (issued within the 50 United States or the District of Columbia) of the provider who is signing the application. The signature must be that of the physician applicant.​​  
• Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification of the physician applicant, 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/ITIN 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.​​ 
• Licensed Primary Care Clinic Cover Letter from at least one Medi-Cal-enrolled clinic at which you provide services. This letter should include the required information as described on page three of the Clinic-Based Provider Bulletin.​​    
• Physician Cover Letter (at least one) that includes the required information as described on page four of the Clinic-Based Provider Bulletin. ​​  
• Fictitious Name Permit (FNP) issued by the Medical Board of California or the Osteopathic 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.​​ 
• 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 Portal select the “California Business Search” link or other appropriate link.​​ 
• 청구 건당 최소 $100,000, 연간 총액 $300,000 이상의 전문직 배상책임보험 증서. 인정되는 증빙 서류는 보험회사 이름, 피보험자 이름, 발효일, 보장 한도 등이 포함된 보험회사에서 발행한 보험증권 또는 신고서입니다. 참고: 캘리포니아주 의료 면허증에 표시된 제공자의 이름이 전문직 배상 책임 보험 확인서에도 표시되어야 합니다.​​ 

PAVE 포털​​ 

PAVE 포털로 이동합니다.​​