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Get Medi-cal Provider Group Application (dhcs 6203) - Denti-cal ... - Denti-cal Ca
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How to fill out the Medi-Cal Provider Group Application (DHCS 6203) - Denti-Cal online
Filling out the Medi-Cal Provider Group Application (DHCS 6203) is a crucial step for healthcare providers seeking enrollment in the Medi-Cal Dental Program. This guide provides a clear and supportive walkthrough to assist you in completing the application online.
Follow the steps to successfully complete your application.
- Use the ‘Get Form’ button to obtain the Medi-Cal Provider Group Application (DHCS 6203) and open it for completion.
- Begin by filling in the 'Enrollment action requested' section. Check all applicable boxes, indicating whether you are a new provider, changing your business address, or need to report other changes.
- Provide your legal and business names. If you have a fictitious business name, ensure you attach the appropriate documentation.
- Enter your provider group telephone number, business address, and ensure the address is a valid physical location, not a P.O. Box.
- Complete the sections for your Taxpayer Identification Number (TIN) and any applicable National Provider Identifier (NPI). Attach legible copies of necessary documents.
- List all rendering providers within your group, including their professional license numbers and dates of birth. Ensure to use additional sheets if necessary.
- Confirm and provide information related to insurance coverage, including liability insurance and proof of worker's compensation insurance if applicable.
- Review all fields for accuracy and completeness. Enter your signature and the date of submission in the designated section.
- Attach all required supporting documents for the application and check that nothing is left blank; use 'N/A' where not applicable.
- Once completed, save your changes and download the document. You may print it for mailing or share it as necessary.
Complete your Medi-Cal Provider Group Application online to ensure timely enrollment.
You can submit Medi-Cal claims through electronic filing or manually by sending paper claims to the designated Medi-Cal addresses. Make sure to follow the guidelines outlined in the Medi-Cal Provider Group Application (DHCS 6203) - Denti-Cal ... - Denti-cal Ca. It's also useful to verify that your claims meet all requirements to ensure timely processing.
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