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  • Cms/nhsp Irf. Inpatient Reporting Form - Dhcs Ca

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California Newborn Hearing Screening Program Outpatient Screening Reporting Form Please complete this form and Fax to (800) 866-1074 or Mail to the Northern California Hearing Coordination Center,.

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Medi-Cal is California's version of the Federal Medicaid program. Medi-Cal offers no-cost and low-cost health coverage to eligible people who live in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program.

Claims Submission LINE OF BUSINESSADDRESSMedi-CalCalifornia Health and Wellness Plan Attn: Claims PO Box 4080 Farmington, MO 63640-3835

​​​Provider Identification Number The Provider Identification Number (PIN) is the additional validation of an enrolled provider's identity that is used when a provider conducts business transactions with the Medi-Cal program and the fiscal intermediary, Xerox State Healthcare, LLC (Xerox).

The TIN for individuals and sole proprietorships is the Social Security Number (SSN).

Legal Entity Numbers are assigned by the State Department of Health Care Service (DHCS), County Claims Customer Service Section. The Legal Entity number is a five digit number issued by DHCS. If a number has not been assigned, then complete the Legal Entity File Update (LEFU) MC 5829 form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232