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Get Form 6166

You can submit the DHCS 6166 form by fax to 916-440-5677 or send via postal service to Medicare Operations Unit P. Ca.gov and to inform counties of the online availability of form DHCS 6166 State Medicare Buy-In Problem Report with the option to be submitted online to MOU for processing. Shortly after the release of ACWDL 09-24 the department s Information Security Officer ISO determined the online usage of form DHCS 6166 violated the Department.

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