Get April 1, 2011 Letter To Icf/dd, Dd-h And Dd-n Providers Regarding ... - Dhcs Ca

This guide will assist you in completing the April 1, 2011 Letter To ICF/DD, DD-H And DD-N Providers Regarding ... - Dhcs Ca online. Follow the steps carefully to ensure that all necessary information is accurately submitted.

Follow the steps to successfully fill out the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated online form editor.
2. Fill in the provider's information, ensuring to accurately enter the Medi-Cal provider number, as this will help in processing your form efficiently.
3. Provide the total resident days for the specified month as instructed in the form. This should include all relevant categories, such as Medi-Cal Managed Care and private pay.
4. Calculate the total amount due by multiplying the total resident days by the specified fee ($9.05) and input this figure in the designated field.
5. Indicate the total amount you are remitting alongside the form, ensuring this figure matches the total amount due calculated earlier.
6. Sign the form in the designated area using a pen. Include the date of completion within the specified field.
7. Enter your contact phone number in the provided space to facilitate any necessary communication regarding your submission.
8. Review all fields for accuracy before finalizing your form. Once confirmed, you can save your changes, download, print, or share the completed form as needed.

Ensure you complete the submission of all required documents online to keep your records up to date.