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MEDICAL RENDERING PROVIDER APPLICATIONDISCLOSURE - dhcs ca

MEDICAL RENDERING PROVIDER APPLICATIONDISCLOSURE - dhcs ca 2025

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The document provides detailed instructions for completing the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for physician and allied providers in California. It outlines the requirements for enrollment or continued enrollment in the Medi-Cal program, including necessary documentation, disclosure information regarding any legal issues, and specific application procedures. The form must be completed accurately to avoid denial of enrollment, and it emphasizes the importance of not using staples or correction materials on the application.

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Versions	Form popularity	Fillable & printable
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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I email DHCS provider enrollment?

For Information concerning the Provider Screening Requirements of the Affordable Care Act, you may submit questions via email to PEDACA@dhcs.ca.gov. You also may call the PED Message Center at (916) 323-1945. After reaching the welcome message, please select option 4, then option 1 to speak with a live agent.

What is CA Pave Portal?

The PAVE portal is the Provider Enrollment Divisions (PED) web-based application designed to simplify and accelerate enrollment processes.

How long does a pave application take?

Processing and approval of the application takes approximately 1 month. Check your PAVE inbox frequently for approval information. Once your application is approved, you will receive a letter in your PAVE inbox.

What is the pave portal for?

What is PAVE? The Provider Application and Validation for Enrollment (PAVE) system is an interactive, web- based solution for the provider types who enroll with Medi-Cal through PED and manage their Medi-Cal accounts securely online.

What is the pave program?

The PAVE program consists of a series of modules that provide participants with knowledge and skills that better enable them to speak out against violence in their communities.

How to be a Medi-Cal provider?

In order to enroll in Medi-Cal, providers must submit an e-Form application using the Provider Application and Validation for Enrollment (PAVE) Provider Portal which is an improved web-based alternative to the former paper application enrollment process.

What is a rendering Medi-Cal provider?

A rendering provider is the healthcare provider who actually renders medical care to a patient. This is a physician, nurse practitioner, or other licensed provider who performs the clinical procedures, tests, or consultations for which a patient is requesting.

What is the purpose of pave?

PAVE helps enhance public understanding of driverless technology through: An educational website and social media channels. Hands-on demonstrations that allow the public to see and experience driverless technology.

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