Get Provider File Update - California Department Of Health Care Services - Dhcs Ca

Filling out the Provider File Update form for the California Department of Health Care Services is an essential step for health care providers looking to update their information. This guide will assist you in completing the form with clarity and confidence.

Follow the steps to successfully complete your Provider File Update.

1. Click ‘Get Form’ button to access the online version of the Provider File Update.
2. Select the type of transaction by checking one of the options: Add, Change, or Inactivate. This determines the nature of your updates.
3. Enter the legal entity number if you have one. If none is assigned, note that you will need to complete a Legal Entity File Update form.
4. Indicate the county submitting the form. Ensure you clearly state the name of the county.
5. Fill in the county code, which is assigned by DHCS. Leave this blank if you do not have it.
6. Provide your provider number, which is issued by DHCS for your facility.
7. Enter the National Provider Identifier (NPI), ensuring it matches the details on the NPI website.
8. Indicate if the provider is a satellite clinic by selecting either Yes or No.
9. Complete the provider name and address fields, ensuring this information reflects the service facility accurately.
10. Document the provider service start date, marking when the county first contracts with the provider.
11. Record the provider service end date if applicable, noting when the contract ends or if the provider has closed.
12. Specify the provider type by selecting from the list provided, matching the appropriate code.
13. Identify the contract type by checking the relevant option from the provided list.
14. Determine the mode of service by selecting from the relevant options available.
15. Complete the service function section with the appropriate code from the definitions provided.
16. Once all sections are filled, review your entries for accuracy and clarity.
17. Save your changes, and then you may choose to download, print, or share the completed form as needed.

Complete the Provider File Update form online today to ensure your information is up to date.