Impormasyon sa Application ng Pasilidad ng Independent Diagnostic Testing
Alinsunod sa Titulo 42, CFR, Seksyon 410.33, Mga Sentro para sa mga Serbisyo ng Medicare at Medicaid, at ang Manwal ng Medicaid ng Estado, Seksyon 3490 hanggang 3490.14, Ang mga tagapagbigay ng serbisyo ng Independent Diagnostic Testing Facility (IDTF) ay karapat-dapat lamang na magpatala sa programang Medi-Cal bilang mga tagapagbigay ng serbisyong "Medicare Crossover Only" upang makatanggap ng reimbursement para sa mga serbisyo ng Medicare Part B.
Independent Diagnostic Testing Facilities are required to submit their application via PAVE (Provider Application and Validation for Enrollment).
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).