Follow the steps to successfully fill out the CA Medi-Cal Pcf30-1 Comp form online.

1. Press the ‘Get Form’ button to obtain the CA Medi-Cal Pcf30-1 Comp form and open it in your preferred digital editor.
2. Begin by filling in the Claim Control Number, which is assigned by the CA Medi-Cal Fiscal Intermediary for tracking purposes. Leave this field blank when submitting the claim.
3. Enter the ID Qualifier by placing a ‘05’ for Pharmacy Provider.
4. Fill in the Provider ID with your unique provider number. Do not use a Medicare provider number.
5. Input your Provider Name, Address, and Phone Number. Ensure this information is accurate before submission.
6. Enter the nine-digit ZIP code of the pharmacy to ensure correct reimbursement.
7. Complete the Patient Name field with the patient’s last name, first name, and middle initial as applicable.
8. Input the Medi-Cal Identification Number as it appears on the Beneficiary's Identification Card.
9. Indicate the Patient's Sex by entering 'M' for male or 'F' for female as per the Beneficiary's details.
10. Record the Date of Birth in the MMDDCCYY format, adhering to the structure for successful processing.
11. Continue filling out each section of the form including relevant drug details, prescription number, billing information, and additional remarks as needed.
12. Once completed, ensure you save your changes. You may download, print, or share the completed form as necessary.

Complete your CA Medi-Cal Pcf30-1 Comp form online today for a streamlined billing process.