Get Dm Ii Ahf Contract - Department Of Health Care Services - State Of ...

Filling out the DM II AHF Contract can seem daunting, but this guide provides clear, step-by-step instructions to help you navigate the process with ease. Follow these instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the DM II AHF Contract online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the agreement number on the first line. This number uniquely identifies your contract.
3. Provide the contractor's name in the designated field, ensuring that it matches the registered name of your organization.
4. Enter your federal ID number as it appears in your tax records.
5. Specify the agency that is transmitting this agreement, which in this case is the Department of Health Care Services.
6. Indicate the division or bureau responsible, here it should be noted as Medi-Cal Benefits, Waivers Analysis, & Rates.
7. Input the agency billing code that corresponds to your organization's billing setup.
8. Fill out the contact information for the contract analyst. This includes their name and phone number for any questions you may have.
9. Answer whether your agency has contracted for these services before, and if so, provide the prior contractor's name and agreement number.
10. Briefly describe the services being provided in no more than 72 characters, being as concise as possible.
11. In the agreement outline, include reasons for the agreement and any specific problems or needs that necessitate it.
12. Indicate the payment terms applicable for this contract, choosing from the listed options.
13. Detail projected expenditures and complete the corresponding budget sections accurately.
14. Provide all necessary documentation and reports as required in the agreement and ensure to attach any additional pages if necessary.
15. Once all fields are filled, review the entire document to ensure accuracy.
16. After verifying, save changes, download, print, or share the completed form as needed.

Complete your DM II AHF Contract online today to ensure a smooth submission process!