Complete the DHCS 4468 provider`s registration request and send it by secure email to This is the first form in the application process. You will receive the others after it has been approved. For any questions, please contact us at or (916) 650-0414. In accordance with the social and institutional code 24005 (i) (3), the department immediately and without notice … if a claimant has not applied for reimbursement under the program for one year. Keep in mind that suppliers are required to notify practitioner staff changes to DHCS OFP and PED within 35 days of the action taken and to complete the required training described above. Effective January 1, 2019, the Department of Health Care Services will begin the process of deactivating Family PACT providers who have not applied for reimbursement in a year. When transmitting changes to a Medi-Cal data set (service address, NPI, TIN, legal name or company name), vendors must indicate these changes by sending a package of applications to the Family PACT vendor`s registration. For these changes, a supplier is not required to focus on certifying the site. Due to numerous registered addresses, correspondence has never been received or updated to the account.

This led to the termination of my Medicaid provider contract. There are no established seats in the W-I code, Section 14043.26 d) D) (D) (d) d) and Title 22, Section 51000.60 of La Ccr, indicating only that it was not possible to have a fixed seat at the address of the office for which the application was filed at the time of a review or review pursuant to a Medi Cal regulation or regulation justifying the rejection of the application. Applicants must meet the applicable requirements of the place of activity, unless the practice of the supplier`s profession or the provision of services, goods, supplies or goods are delivered or delivered to places other than those mentioned in the declaration, and that practice or delivery has not been disclosed in the application package and approved by the Department. The provider does not have the necessary licence to provide the required W-I code, Section 14043.26 (4)) (B) which states that an application form is refused when an applicant does not have the necessary licence to provide health services or to provide goods or goods directly or indirectly to a Medi-Cal recipient in the relevant service category or subgroup of services. The only argument put forward by the petitioner is that DCHS erred in terminating its Medicaid supplier contract because it had been the victim of «false and false allegations». P. The deactivation of the Family PACT program has no influence on the Medi-Cal recording. Deactivated vendors are informed by a letter sent to the address by file. DHCS 4469 and DHCS 4470 are made available to applicants after approval of Form DHCS 4468. Please note that DHCS 4470 should not be completed by primary care clinics, affiliate care clinics, FQHCs, RHCs, IHs and public providers. The Family PACT program ends the annual PAH card distribution policy with annual limits. All PAH card order requests are forwarded to the Office of Family Planning for verification.

All additional PAH card requests and the number of additional cards approved are verified on a case-by-case basis. Initial PAH card orders for all new suppliers remain at 200 sequential cards and 50 empty PAH cards. The telephone service centre continues to process approved PAH card distributions.