合格

此註冊類型僅適用於專屬於 Medi-Cal 註冊的持牌基層醫療診所提供醫療服務，並沒有其他經營地點（即醫療辦公室）提供服務，並需要為一般急性醫療醫院或急性精神科醫院的受益人收費收費的住院服務的個人醫生。 群組不符合此類型的註冊資格。

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).

授權

在申請 Medi-Cal 之前，請先查看加州醫學委員會或加州整骨醫學委員會，以確保您符合所有執照要求。      

所需文件

接下來，收集下面列出的所需文件（視適用），以便在完成 PAVE 申請時將它們上傳到 PAVE。 請確保上傳的文件易於閱讀。

• 申請人或服務提供者的有效加州行醫執照或整骨醫師及外科醫師執照。如有，請附上美國緝毒局（DEA）所核發的證書。
• 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. 
• 如果未使用社會安全號碼，則需提交由美國國稅局 (IRS) 簽發的最新文件，以驗證醫生申請人的聯邦雇主識別號碼 (FEIN) 或個人納稅人識別號碼 (ITIN) 。唯一可接受的文件包括 IRS 簽發的 147-C 號信函、IRS 出具的 941 表格（雇主季度聯邦納稅申報表）、IRS 出具的 8109-C 表格（存款憑證）或 IRS 出具的 SS-4 表格（僅限 FEIN/ITIN 分配的正式確認通知）。注意：申請表上申請人或提供者的法定姓名必須與國稅局所發出的文件上的姓名完全一致；且申請人/提供者必須是國稅局文件中所列實體的所有者或負責人。如需了解更多信息，請訪問美國國稅局網站或致電 (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.
• 專業責任保險證書，每宗賠償金額不少於 10 萬元，年度最低總計 30 萬元。 可接受的驗證是保險公司發出的保險證明書或聲明表，其中包含保險公司名稱、受保人名稱、生效日期和保障限制。 注意：加州醫療執照上顯示的提供者名稱也必須顯示在職業責任保險的驗證中。

鋪路門戶

前往 P AVE 門戶。