Get Ca Dhs 3092 2005-2026

This guide provides a comprehensive overview of how to accurately complete the CA DHS 3092, also known as the Medi-Cal Supplemental Cost Report. Designed for a variety of users, this step-by-step approach ensures that your submission meets all necessary requirements for timely processing.

Follow the steps to successfully complete the CA DHS 3092 online.

1. Press the 'Get Form' button to access the CA DHS 3092 and open it for completion.
2. Begin with Schedule 1, which is the Medi-Cal cost report acceptance page. Ensure that all financial statements and working trial balances are submitted, as these are critical for acceptance.
3. Move to Schedule 2, the required worksheets and schedules checklist. Here, verify that you have included all necessary documents. If needed, use separate blank forms for repeated schedules.
4. Next, complete Schedule 3, the certification page. This requires the signature of the chief executive officer or an authorized person, confirming the accuracy of the report.
5. Proceed to Schedule 4, the provider questionnaire. Fill in essential details such as the provider name, address, and contact information, indicating whether the cost report is filed on a consolidated basis.
6. Continue with Schedule 5, which addresses provider-based physicians. Ensure accurate reporting of services, compensation, and billing methods for these physicians.
7. Complete Schedule 6, summarizing Medi-Cal charges. Include detailed breakdowns of charges for various services provided in the given fiscal period.
8. Fill out Schedule 7 for the summary of the Medi-Cal settlement, documenting the settlement details from the Medi-Cal cost report accurately.
9. For psychiatric services, complete Schedule 8 with all relevant details of inpatient psychiatric services, ensuring compliance with the cost reporting requirements.
10. Complete Schedule 9 and Schedule 10 if applicable, focusing on the summary of costs and settlements for rural health clinic or federally qualified health center services.
11. Finally, wrap up with Schedule 11, the credit balance report for inpatients and outpatients, ensuring all outstanding balances are accurately reported.
12. Once all sections are filled out, review your entries for accuracy. You can then save your changes, download the document, print it, or share it as required.

Start filling out the CA DHS 3092 online today to ensure your timely and accurate submission!