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Instructions for Form DHCS100186 Drug Medi-Cal (Dmc) Claim Submission Certification - County Contracted Provider - California
This document contains official instructions for Form DHCS100186 , Drug Medi-Cal (Dmc) Claim Submission Certification - County Contracted Provider - a form released and collected by the California Department of Health Care Services. An up-to-date fillable Form DHCS100186 is available for download through this link.
FAQ
Q: What is Form DHCS100186?A: Form DHCS100186 is the Drug Medi-Cal (Dmc) Claim Submission Certification for County Contracted Providers in California.
Q: Who is this form for?A: This form is for County Contracted Providers in California who are filing Drug Medi-Cal claims.
Q: What is Drug Medi-Cal (Dmc)?A: Drug Medi-Cal (Dmc) is a program that provides substance use disorder treatment services to eligible individuals in California.
Q: What is the purpose of this form?A: The purpose of this form is to certify that the services provided by the County Contracted Provider are eligible for reimbursement through the Drug Medi-Cal program.
Q: Are there any specific requirements for filling out this form?A: Yes, the form must be completed accurately and all required information must be provided.
Q: What are some of the required information needed for this form?A: Some of the required information includes provider information, claim details, and signature of a responsible official.
Q: Is there a deadline for submitting this form?A: Yes, the form must be submitted within 90 days of the date of service.
Q: What happens after submitting this form?A: After submitting this form, the County Contracted Provider will receive reimbursement for the eligible services provided.
Q: Is there any other documentation that needs to be submitted along with this form?A: Yes, additional supporting documentation may be required depending on the nature of the services provided.
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.
