Form DHCS6216 Medi-Cal Rendering Provider Application / Disclosure Statement / Agreement for Physician / Allied / Dental Providers - California

What Is Form DHCS6216?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHCS6216 form?A: The DHCS6216 form is the Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers in California.

Q: Who is required to fill out this form?A: Physicians, allied health professionals, and dental providers who want to participate in the Medi-Cal program in California are required to fill out this form.

Q: What information is included in the form?A: The form includes information about the provider's background, education, experience, and professional credentials, as well as their agreement to comply with Medi-Cal program requirements.

Q: How long does it take to process the form?A: The processing time for the form can vary, but it typically takes several weeks to a few months for the California DHCS to review and approve the application.

Q: Is there a fee to submit the form?A: There is currently no fee to submit the DHCS6216 form for physician, allied health professional, or dental provider applicants.

Q: What happens after the form is approved?A: Once the DHCS6216 form is approved, the provider will be enrolled in the Medi-Cal program and will be eligible to provide services to Medi-Cal beneficiaries.

Q: Can I make changes to my information after submitting the form?A: Yes, you can make changes to your information after submitting the form. You will need to contact the Medi-Cal provider enrollment department to update your information.

Q: What should I do if I have questions about the form?A: If you have any questions about the DHCS6216 form or the Medi-Cal provider enrollment process, you can contact the California DHCS or the Medi-Cal provider enrollment department for assistance.