Get Medi-cal Rendering Provider Application/disclosure ... - Denti-...

The Medi-Cal Rendering Provider Application/Disclosure is essential for individuals seeking to provide dental services under the California Medi-Cal Dental Program. This guide will walk you through the steps to effectively complete the form online.

Follow the steps to fill out the form successfully.

1. Press the ‘Get Form’ button to access the document and open it for editing.
2. Begin by entering the billing provider name. This is the name of the individual or organization submitting the application.
3. Fill in your NPI (National Provider Identifier) number and billing number. These identifiers are crucial for the processing of your application.
4. Provide the complete mailing address, including city, state, and ZIP code. Ensure accuracy to avoid delays in communication.
5. Enter your telephone number and any relevant fax number where necessary. This will facilitate easy communication with Medi-Cal.
6. Select the forms you wish to reorder based on your needs from the listed options, including various claim forms and envelopes.
7. Indicate the quantity required for each form you are ordering, ensuring you select a number that meets your operational requirements.
8. Review all the information provided for accuracy. It is crucial to ensure that there are no errors before submission.
9. Save the changes made to the form. You may also download, print, or share the completed form as needed.

Complete and submit your documents online to ensure efficient processing.