Get Ca Dhcs 6246 2017-2026

The CA DHCS 6246 form is a crucial document for Medi-Cal providers to establish or modify their Electronic Health Care Claim Payment/Advice Receiver Agreement. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the CA DHCS 6246 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor. This will allow you to start filling out the required details.
2. Begin by filling in the Identification of Parties section, confirming your role as the Provider. Ensure the provider information matches the current records with DHCS Provider Enrollment.
3. Complete the Provider Information section in full detail, including your Provider Name, Provider Number, and Tax Identification Number or Social Security Number.
4. In the Provider Service Address fields, provide your complete service address, including city, state, and zip code.
5. Designate a Contact Person and provide their contact information, including phone number and email address.
6. Fill in the Receiver Information section if applicable. You can designate two entities to receive the 835-Transaction.
7. For each Receiver, fill in their full legal name, contact information, and receiver identification number.
8. Review the Background Information and Definitions to ensure you understand the terms before moving forward.
9. Submit the form once all required fields are completed. The application can be saved for review, downloaded, printed, or shared for further verification.

Complete your CA DHCS 6246 form online today to ensure prompt processing of your electronic health care claims.