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  • Ca Dhcs 6246 2017

Get Ca Dhcs 6246 2017-2025

State of California Health and Human Services AgencyDepartment of Health Care ServicesELECTRONIC HEALTH CARE CLAIM PAYMENT/ADVICE RECEIVER AGREEMENT (ANSI ASC X12N 835Transaction) TYPE OF AUTHORIZATION:NEWCHANGECANCELIDENTIFICATION.

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​​Here is more information on how to: Apply for Medi-Cal, get a Medi-Cal Application, or Find Out if you Qualify....​Medi-Cal Contacts. GENERAL PUBLICPHONE / EMAILMedi-Cal Eligibility P.O. Box 997417, MS 4607 Sacramento, CA 95899-7417(916) 552-920014 more rows • Sep 2, 2022

Then you may submit your request one of these ways: To the county welfare department at the address shown on the Notice of Action. To the California Department of Social Services. ... To the State Hearings Division by fax to (833) 281-0905. To the California Department of Social Services at the online hearing request page.

Timeliness: 90-Day Deadline Providers must submit an appeal in writing within 90 days of the action/inaction precipitating the complaint. Failure to submit an appeal within this 90-day time period will result in the appeal being denied. (See California Code of Regulations, Title 22, Section 51015.)

An appeal may be submitted for unsatisfactory responses to the processing, payment and resubmission of a claim or a claim inquiry. The California MMIS Fiscal Intermediary reviews each case individually using the documents presented by a provider to render a fair decision.

The California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 9-17-37, Sacramento, California 94244-2430; To the State Hearings Division at fax number (916) 651-5210 or (916) 651-2789; or.

Providers who seek an appeal must initiate action by submitting a complaint in writing that identifies the claim and describes the disputed action or inaction. The simplest way is to use an Appeal Form (90-1) to identify the disputed claim. The FI accepts appeals related to claims processing issues only.

The Claims Inquiry Form (CIF) is used to request an adjustment for either an underpaid or overpaid claim, request a Share of Cost (SOC) reimbursement or request reconsideration of a denied claim. The CIF can also be used as a tracer.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232