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Form DHCS4503 Laboratory Provider Program Agreement - California
What Is Form DHCS4503?
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 DHCS4503 Laboratory Provider Program Agreement?
A: The DHCS4503 Laboratory Provider Program Agreement is a document that outlines the agreement between a laboratory provider and the California Department of Health Care Services (DHCS).
Q: What is the purpose of the DHCS4503 Laboratory Provider Program Agreement?
A: The purpose of this agreement is to ensure that laboratory providers meet the requirements set forth by the DHCS in order to participate in the Laboratory Provider Program.
Q: What is the Laboratory Provider Program?
A: The Laboratory Provider Program is a program administered by the DHCS that allows laboratory providers to participate in the Medi-Cal program and receive reimbursement for covered laboratory services.
Q: Who needs to sign the DHCS4503 Laboratory Provider Program Agreement?
A: Both the laboratory provider and the DHCS need to sign the agreement.
Q: What are the key requirements for laboratory providers in the DHCS4503 Laboratory Provider Program Agreement?
A: The agreement outlines requirements such as compliance with applicable laws and regulations, maintaining an appropriate licensure and certification, and submitting accurate and timely claims for services.
Q: How long does the DHCS4503 Laboratory Provider Program Agreement remain valid?
A: The agreement remains valid until it is terminated or expired; however, the DHCS may revise the agreement from time to time.
Q: What happens if a laboratory provider violates the terms of the DHCS4503 Laboratory Provider Program Agreement?
A: If a laboratory provider violates the terms of the agreement, the DHCS may take enforcement actions such as suspension or termination from participating in the Laboratory Provider Program.
Form Details:
- Released on January 1, 2008;
- 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 DHCS4503 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
