Facility-Based Providers Application Instructions
This type of enrollment is for individual healthcare providers and groups of healthcare providers who provide medical services exclusively in one or more Licensed Health Facilities that are also actively-enrolled in Medi-Cal. Licensed Health Facilities that are included in this type of enrollment are those defined in the California Health & Safety Code Sections 1250 -1250.3.
Pursuant to the regulatory Provider Bulletin published in the February 2005 Medi-Cal Update, DHCS has established procedures for the enrollment of licensed or certificated healthcare providers, or applicants who are professional corporations, who render services to Medi-Cal beneficiaries exclusively in one or more licensed health facilities that are enrolled in the Medi-Cal program. This bulletin refers to such persons or professional corporations as "facility-based providers". In order to determine whether or not you qualify for this type of enrollment, please read the detailed Provider Bulletin "Requirements and Procedures for Enrollment as a Facility-Based Provider".
If you qualify to enroll as a Facility-Based Provider or Provider Group: Facility-Based providers are required to submit their individual and/or group applications via PAVE (Provider Application and Validation for Enrollment). If you are submitting a group application, please ensure you also submit at least two rendering applications in PAVE in order to form your group.
Cover Letters Required to be uploaded into PAVE for Facility-Based Provider Enrollment:
Health Care Facility Cover Letter must be on facility letterhead, from each Medi-Cal enrolled and licensed health facility at which you render services to Medi-Cal beneficiaries. The requirements for the information needed and a suggested format for this letter can be found on pages two and four of the "Facility-Based Provider Bulletin". N.B. This letter is not required for facility-based anesthesiologists who do not have a contract with a licensed health facility/facilities.
Provider Cover Letter, a letter from you, the provider or provider group, that lists each Medi-Cal enrolled and licensed health facility at which you render services to Medi-Cal beneficiaries. The requirements for this letter and a suggested format for this letter can be found on pages two and five of the "Facility-Based Provider Bulletin".
Provider Cover Letter for an anesthesiologist or group of anesthesiologists who don’t have a contract with a licensed health facility(ies), a letter which lists all of the Medi-Cal enrolled and licensed health facilities at which you render services to Medi-Cal beneficiaries. The requirements for this letter and a suggested format for this letter can be found on pages three and six of the "Facility-Based Provider Bulletin".
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Last modified date:
3/23/2021 8:57 AM