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Get Medi-cal Rendering Provider Application/disclosure Statement/agreement For Physician/allied/dental

Ng Provider application includes the Medi-Cal Rendering Provider/Group/Affiliation/Disaffiliation Form (DHCS 4029, Rev. 12/16). DHCS 4029 is available at files.medi-cal.ca.gov/pubsdoco/forms.asp and must be submitted with the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216, Rev. 5/17). Thank you for your recent inquiry regarding participation in the Medi-Cal program. Please complete the enclosed Medi-Cal provider enrollment.

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Related content

Updated Disclosure Statement and Rendering...
The updated forms are available from the Forms page and the “Application Forms by Form...
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Cal. Code Regs. Tit. 22, § 51000.31 | State...
Apply for enrollment in the Medi-Cal program by submitting a "Medi-Cal Rendering Provider...
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Medi-Cal-Provider-Manual.pdf
The. Provider Manual is a reference tool that contains eligibility, benefits, contact...
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Contact support

For general questions about Medi-Cal, members and medical providers can call the official helpline at 1-800-541-5555. Depending on the situation, you may also call Covered California at 1-800-300-1506 or your county's Medi-Cal office.

Currently, a total of 24 plans contract with the Department of Health Care Services (DHCS) to provide Medi-Cal managed care services to beneficiaries.

The Provider Application and Validation for Enrollment (PAVE) system is an interactive, web- based solution for the provider types who enroll with Medi-Cal through PED and manage their Medi-Cal accounts securely online.

If you are a provider type not yet eligible to submit an application via PAVE, you can request that a Medi-Cal enrollment application be mailed to you by calling the Medi-Cal Provider Service Center at (800) 541-5555(outside of California, please call (916) 636-1980).

To verify enrollment with State Medi-Cal, you may search the Department of Health Care Services' (DHCS) database via one or both of the links below (Enter your National Provider Identifier (NPI) in the search field).

Check your Medi-Cal Benefit Status By Smart Phone or Tablet. Visit BenefitsCal to: By Desktop Computer. To check your benefits with a desktop computer visit BenefitsCal.com. By Phone. To check the status of your benefits, visit BenefitsCal.com or call 888-472-4463. Request a replacement Benefit Issuance Card (BIC)

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232