Impormasyon sa Application ng Nurse Practitioner
Mga Praktisyon ng Nars ay kinakailangang isumite ang kanilang mga indibidwal at/o grupong aplikasyon sa pamamagitan ng PAVE (Provider Application and Validation for Enrollment). Kung nagsusumite ka ng panggrupong aplikasyon, pakitiyak na nagsusumite ka rin ng hindi bababa sa dalawang rendering application sa PAVE.
Paglilisensya
Bago mag-apply sa Medi-Cal, suriin muna sa California Board of Registered Nursing para matiyak na natutugunan mo ang lahat ng kinakailangan sa paglilisensya.
Mga Kinakailangang Dokumento
Susunod, tipunin ang mga kinakailangang dokumento na nakalista sa ibaba, kung naaangkop, upang ma-upload ang mga ito sa PAVE habang kinukumpleto mo ang iyong aplikasyon sa PAVE. Pakitiyak na ang mga na-upload na dokumento ay nababasa.
1. California Registered Nurse License at Certificate of Nurse Practitioner mula sa isang pambansa o estadong organisasyon na kinikilala ng California Board of Registered Nursing, at tinukoy ang lugar ng pagsasanay sa espesyalisasyon.
2. Lisensya sa Pagmamaneho o mga kard ng pagkakakilanlan na ibinigay ng estado (ibinigay sa loob ng 50 Estados Unidos o Distrito ng Columbia) para sa aplikante.
3. Sertipiko ng Professional Liability Insurance sa halagang hindi bababa sa $100,000 bawat claim at isang minimum na taunang pinagsama-samang $300,000. Ang katanggap-tanggap na pag-verify ay isang sertipiko ng seguro o sheet ng deklarasyon na inisyu ng kumpanya ng seguro na naglalaman ng pangalan ng kumpanya ng seguro, ang pangalan ng nakaseguro, mga petsa ng bisa, at mga limitasyon ng saklaw. Tandaan: Ang pangalan ng provider, tulad ng makikita sa California Registered Nurse License at Nurse Practitioner Certificate, ay dapat ding ipakita sa verification ng professional liability insurance.
4. For ‘individual stand alone enrollment’: Federal Employer Identification Number (FEIN) 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 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.
5. For ‘individual stand alone enrollment’: Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number if applicable, of the applicant or provider on the application must exactly match the insured’s name and address on the certificate of insurance or declaration sheet.
6. For ‘individual stand alone enrollment’: Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name and business address of the applicant or provider must match the insured’s name and address on the certificate of insurance.
7. For ‘individual stand alone enrollment’: Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
8. For ‘individual stand alone enrollment’: Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
9. For ‘individual stand alone enrollment’: Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”
10. For ‘individual stand alone enrollment’ : Kung ang iyong negosyo ay isang korporasyon, ang mga pagkaantala sa pagproseso ay maaaring iwasan sa pamamagitan ng paglakip ng kopya ng inihain na Mga Artikulo ng Pagsasama mula sa Kalihim ng Estado, at isang listahan ng mga pangalan at titulo ng mga direktor at opisyal, na may porsyento ng pagmamay-ari at kontrol na interes para sa bawat isa.
To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
11. For ‘individual stand alone enrollment’: If your business is a partnership, a fully executed Partnership Agreement. Processing delays may be avoided by indicating whether the entity is a General Partnership or Limited Partnership and also submitting the following:
a) Para sa isang Pangkalahatang Pakikipagsosyo, isang listahan ng lahat ng mga kasosyo na may porsyento ng pagmamay-ari o kontrol na interes para sa bawat isa; o
b) Para sa Limited Partnership, impormasyong nagpapakilala sa General Partner at isang listahan ng lahat ng partner na may porsyento ng pagmamay-ari o kontrol na interes para sa bawat isa.
Upang i-verify o baguhin ang pangalan at/o katayuan ng iyong pakikipagsosyo o para sa karagdagang impormasyon, mangyaring bisitahin ang Secretary of State California Business Portal at mag-click sa link na "California Business Search" o iba pang naaangkop na link.
12. For ‘individual stand alone enrollment’: Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.