Get Instructions For Completing The Cpsp Provider Application Cdph 4448 3202012

This guide provides a comprehensive overview of how to accurately fill out the Instructions For Completing The CPSP Provider Application CDPH 4448 3202012 online. Following these steps will help ensure that your application is completed correctly and efficiently.

Follow the steps to complete your CPSP provider application online.

1. Click the ‘Get Form’ button to obtain the application form and open it for editing.
2. Complete Section 1 by providing your identifying information, including your legal name, service address, billing address, and contact details. Ensure that your legal name matches exactly with the Federal Internal Revenue Service Tax Identification.
3. In Section 2, check the appropriate provider type that applies to you.
4. For Section 3, respond to the query about being a current Medi-Cal provider with 'yes' or 'no.' If yes, include your National Provider Identifier (NPI) number and your former Medi-Cal Provider Number.
5. In Section 4, list all practitioners who will provide comprehensive perinatal services. Fill in their legal names, types, licensing information, years of experience, and the functions they will perform.
6. Section 5 requires you to indicate any state-sponsored training received related to CPSP services. Provide details as necessary.
7. Attach the sequentially numbered required documents mentioned in Section 6, including prenatal medical records and care plans.
8. Complete Section 7 by providing the total number of deliveries performed in the last 12 months and any additional information relevant to your application.
9. Sign the application and date it before submitting to the local CPSP Perinatal Services Coordinator.
10. Finally, save your changes, and then download or print the completed form for submission.

Complete your CPSP provider application online today to ensure timely processing of your submission.