Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send recipient provider via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out dhcs 6170 form with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
Click ‘Get Form’ to open the dhcs 6170 form in the editor.
Begin by filling in the 'County Information' section. Enter the county submitting the form, county code, and NPI number. If applicable, indicate whether the provider is activating any modes or changing names.
Next, complete the 'Provider Information' section. Fill in the provider's name, address, number, city, and zip code accurately.
In the 'Services Provided' section, check all applicable services offered by your organization. Ensure you include outpatient and residential services as required.
Proceed to answer each question under 'Evaluation Criteria'. Provide clear responses regarding policies and procedures related to health information and facility standards.
Finally, ensure that all signatures are completed at the bottom of the form before submitting it via email or fax as indicated.
Start using our platform today for free to streamline your document editing and completion process!
DHCS is the single state agency responsible for financing and administering the states Medicaid program, Medi-Cal, which provides health care services to low-income persons and families who meet defined eligibility requirements. Medi-Cal is authorized and funded through a federal-state partnership.
What is the name of the California DHCS insurance program?
Medi-Cal is Californias Medicaid program.
What is a subcontractor in DHCS?
Subcontractor an individual or entity that has a Subcontractor Agreement with the MCP that relates directly or indirectly to the performance of the MCPs obligations under its contract with DHCS.
What is legal entity number DHCS?
LEGAL ENTITY NUMBER: The Legal Entity is the owner of the Provider. Legal Entity Numbers are assigned by the State Department of Health Care Service (DHCS), County Claims Customer Service Section. The Legal Entity number is a five digit number issued by DHCS.
What agency is DHCS under?
The California Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.
Related Searches
Dhcs 6170 form pdfDhcs 6170 form downloadDhcs 6170 form online
The California Department of Health Care Services (DHCS) is the backbone of Californias health care safety net, helping millions of Californians every day.
What is DHCS certification?
The Department of Health Care Services (DHCS) has the sole authority to certify and monitor all outpatient alcohol or other drug programs, also known as substance use disorder (SUD) treatment programs that offer treatment, recovery, detoxification, or Medication for Addiction Treatment (MAT) services.
Related links
Final Evaluation of Californias Health Homes Program (HHP)
Jul 4, 2023 The California Department of Health Care Services (DHCS) implemented the Medi-Cal Health. Homes Program (HHP) to serve eligible Medi-Cal
This site uses cookies to enhance site navigation and personalize your experience.
By using this site you agree to our use of cookies as described in our Privacy Notice.
You can modify your selections by visiting our Cookie and Advertising Notice.... Read more...Read less
