Get Short Doyle/medi-cal Monthly Claim For - Department Of ...

Filling out the SHORT DOYLE/MEDI-CAL MONTHLY CLAIM FOR form online can be a straightforward process when guided properly. This guide provides step-by-step instructions to help users complete the claim accurately.

Follow the steps to effectively complete the claim form.

1. Click the ‘Get Form’ button to access the claim form and launch it in the online editor.
2. Begin by entering the claim month and the fiscal year at the top of the form. Ensure that you include the correct name and other identifying information as required.
3. In the designated fields under Columns A and B, enter the amounts expended for skilled professional medical personnel in Column A and for non-medical professionals in Column B.
4. For Line 8 in Column A, input the total expenditures to be reimbursed at the enhanced Federal Medical Assistance Percentage of 75 percent. In Column B, indicate the total for a non-enhanced FMAP of 50 percent.
5. Input the percentage of time staff spent on Quality Assurance/Utilization Review (QA/UR) activities in Line 9 and the percentage of time spent on Medi-Cal QA/UR in Line 10.
6. Complete the calculations for Lines 11 through 15 as necessary, ensuring that all figures and calculations are accurate to reflect claimable amounts.
7. After filling out all sections of the form, double-check for any errors or omissions, then you can save your changes, download, print, or share the completed form as needed.

Complete your forms online today for a streamlined filing experience.