PDF
Word
Instructions for Form DHCS6700 Multiple Billing Override Certification - California
This document contains official instructions for Form DHCS6700 , Multiple Billing Override Certification - a form released and collected by the California Department of Health Care Services. An up-to-date fillable Form DHCS6700 is available for download through this link.
FAQ
Q: What is Form DHCS6700?A: Form DHCS6700 is the Multiple Billing Override Certification form in California.
Q: What is the purpose of Form DHCS6700?A: Form DHCS6700 is used to certify that a provider has a valid written agreement with a patient allowing them to bill the patient for medical services that are normally covered by Medi-Cal or another health insurance.
Q: Who needs to complete Form DHCS6700?A: Healthcare providers who want to bill a patient for services that would otherwise be covered by Medi-Cal or another health insurance need to complete Form DHCS6700.
Q: Is there a fee to submit Form DHCS6700?A: No, there is no fee to submit Form DHCS6700.
Q: Are there any supporting documents required with Form DHCS6700?A: Yes, you will need to attach a copy of the written agreement with the patient.
Q: What happens after I submit Form DHCS6700?A: The California Department of Health Care Services (DHCS) will review your form and notify you of their decision.
Q: How long does it take to process Form DHCS6700?A: The processing time for Form DHCS6700 may vary, but it typically takes several weeks.
Q: Is Form DHCS6700 specific to California?A: Yes, Form DHCS6700 is specific to California and is used for multiple billing override certification in the state.
Instruction Details:
- This 1-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the California Department of Health Care Services.
