Get Ca Dhcs 9098 2010-2026
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How to fill out the CA DHCS 9098 online
The California Department of Health Care Services (CA DHCS) 9098 form is an essential document for institutional providers applying to enroll in the Medi-Cal program. This guide provides detailed instructions on how to fill out the form online, ensuring accuracy and compliance.
Follow the steps to complete the CA DHCS 9098 form online.
- Press the ‘Get Form’ button to access the CA DHCS 9098 online and open it in an editable format.
- Begin with filling in the 'Legal name' section. This should match the name registered with the Internal Revenue Service (IRS).
- Input the 'Business name' if it differs from the legal name. Provide the name of the facility or agency as registered.
- Enter your 'Provider Number (NPI),' which is the ten-digit National Provider Identifier assigned to your business, as registered with the National Plan and Provider Enumeration System.
- Fill in the 'Business telephone number' using the primary contact number for the business.
- Complete the 'Business address' section with the physical location. Include street name, suite or room number, city, county, state, and nine-digit ZIP code. Note that a post office box is not acceptable.
- Provide the 'Mailing address' where you wish to receive correspondence from Medi-Cal, including general updates and bulletins.
- Include the 'Pay to address' where payments should be sent.
- If applicable, state your 'Previous business address.' If not submitting a change, enter N/A.
- Enter your 'Taxpayer Identification Number' (TIN) as issued by the IRS, corresponding to your business.
- Proceed to page 9. Fill the printed name of the person signing the agreement, along with their original signature and title.
- If notarization is required, ensure you complete the 'Notary Public' section with the appropriate acknowledgment.
- Review all sections for completeness. Ensure that no questions are left blank; use 'N/A' where not applicable.
- Once you have filled out the form, you can save your changes, download a copy, print it, or share it as needed.
Complete your CA DHCS 9098 form online today for a smooth enrollment process.
Filling out the Medi-Cal renewal form requires attention to detail and clarity. Begin by gathering all necessary documentation such as income verification and any changes in household status. Then, follow the instructions provided in the form to ensure that you complete it accurately. If you need assistance during this process, US Legal Forms offers templates and guides to simplify your experience.
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