PDF
Word
Form MC0804 Crossover Only Provider Form - California
What Is Form MC0804?
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 Form MC0804?A: Form MC0804 is the Crossover Only Provider Form in California.
Q: What is a Crossover Only Provider?A: A Crossover Only Provider is a provider who is only responsible for billing secondary payers, such as Medicare, after the primary payer has processed the claim.
Q: Who uses Form MC0804?A: Form MC0804 is used by Crossover Only Providers in California.
Q: What is the purpose of Form MC0804?A: The purpose of Form MC0804 is to provide information about the Crossover Only Provider and their billing practices to the appropriate entities.
Form Details:
- Released on October 1, 2010;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form MC0804 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form MC0804 Crossover Only Provider Form - California
1
2
3
4
