ຂໍ້ມູນຄໍາຮ້ອງສະຫມັກຂອງສະຖານທີ່ທົດສອບການວິນິດໄສເອກະລາດ
ອີງຕາມຫົວຂໍ້ 42, CFR, ມາດຕາ 410.33, ສູນບໍລິການ Medicare ແລະ Medicaid, ແລະຄູ່ມື Medicaid ຂອງລັດ, ມາດຕາ 3490 ຫາ 3490.14, ຜູ້ໃຫ້ບໍລິການສູນກວດວິນິດໄສເອກະລາດ (IDTF) ມີສິດລົງທະບຽນເຂົ້າຮ່ວມໂຄງການ Medi-Cal ໃນຖານະເປັນຜູ້ໃຫ້ບໍລິການ "Medicare Crossover Only" ເທົ່ານັ້ນເພື່ອຮັບເງິນຊົດເຊີຍສຳລັບການບໍລິການ Medicare Part B.
ສະຖານທີ່ກວດວິນິດໄສທີ່ເປັນເອກະລາດຕ້ອງໄດ້ຍື່ນໃບສະໝັກຜ່ານ PAVE (ໃບສະໝັກ ແລະ ການກວດສອບຄວາມຖືກຕ້ອງຂອງຜູ້ໃຫ້ບໍລິການ)
1. Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) 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/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.
2. Copy of approval letter as an Independent Diagnostic Testing Facility (IDTF) provider from the Centers of Medicare and Medicaid Services (CMS).