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How to fill out the Dhcs 6248 Form online
Completing the Dhcs 6248 Form correctly is essential for enrollment in the Medi-Cal program. This guide will walk you through each section of the form, providing clear steps to ensure a smooth submission process.
Follow the steps to successfully complete the Dhcs 6248 Form online.
- Click the ‘Get Form’ button to obtain the form and open it for editing.
- Begin with the applicant information section. Ensure to provide your legal name as registered with the Internal Revenue Service (IRS) and attach any necessary identification documents as specified in the guidelines.
- Fill out the driver's license number or state-issued ID details, ensuring the state of issuance is correct. Attach a legible copy of this document.
- Enter your National Provider Identifier (NPI) number. Attach the confirmation from the Centers for Medicare and Medicaid Services/National Plan and Provider Enumeration System (CMS/NPPES).
- Include your social security number or Taxpayer Identification Number (TIN) if applicable. Attach relevant documentation required.
- Complete the fields for personal and employment information, including your date of birth, gender, and details about your credentials and work hours.
- Proceed to the employer section. Enter the legal name of your employing provider and their business address, alongside the provider’s NPI.
- Gather and attach necessary documents such as proof of professional liability insurance and the signatures required from both your supervising physician and the employing provider.
- Review the form for any omitted fields. Ensure all sections are filled out with the appropriate information. Use 'N/A' for non-applicable items.
- Save your changes to the form, and prepare to submit it as per the submission guidelines. You may download, print, or share the completed form as necessary.
Complete your Dhcs 6248 Form online today for a timely submission to the Medi-Cal program.
The DHCS 1801 form is used for various reporting and administrative purposes within the Medi-Cal program. This form helps facilitate operations and ensures compliance with state guidelines. It works in conjunction with other forms like the Dhcs 6248 Form, helping users effectively manage enrollment and benefits.
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