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  • Out-of-state Provider Express Enrollment - Medi-cal - State Of ... - Files Medi-cal Ca

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State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS Director EDMUND G. BROWN JR. Governor Out-of-State Provider Express Enrollment Form Dear Out-of-State Provider in order to enroll as an out-of-state Medi-Cal provider the following information is required Please attach this form to your original claim and mail in. Provider/Facility Name Ambulance circle one Air Ground circle one M.

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You can't transfer state administered benefits to a new state. However, with careful planning you can apply in your new home state without a lapse in benefits.

All health insurance plans regardless of the state of purchase will cover emergency services at any hospital in the United States, with the exception of Hawaii. However, non-emergency care, like primary care visits, might not be covered.

As long as you are eligible, Medi-Cal will cover emergency services and urgent care in another state. We will also cover emergency care that results in hospitalization in Canada and Mexico if the service is approved and the doctor and hospital meet Medi-Cal rules.

Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.

Providers may obtain provider enrollment forms by contacting the Out-of-State Provider Unit at (916) 636-1960 for forms to be mailed or by downloading the appropriate forms from the Medi-Cal website's Provider Enrollment web page. (For questions about which forms to use, contact the Out-of-State Provider Unit.)

Who Is Eligible for Medicaid in California? Medi-Cal is available to California residents who are U.S. citizens, permanent residents, legal aliens or U.S. nationals. There are several ways to qualify for the program. Some individuals qualify based on their household income level.

​Provider Enrollment Division For information concerning Drug Medi-Cal Continued Certification, you can submit questions via email to DHCSDMCRecert@dhcs.ca.gov. For Information concerning the Provider Screening Requirements of the Affordable Care Act, you may submit questions via email to PEDACA@dhcs.ca.gov.

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© Copyright 1997-2025
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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