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Instructions for Form DHCS3100
for the current year.
Instructions for Form DHCS3100 Federally Qualified Health Center / Rural Health Clinic Managed Care Differential Rate Request Form - California
This document contains official instructions for Form DHCS3100 , Federally Qualified Health Center/Rural Health Clinic Managed Care Differential Rate Request Form - a form released and collected by the California Department of Health Care Services.
FAQ
Q: What is Form DHCS3100?
A: Form DHCS3100 is a document used in California for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to request a managed care differential rate.
Q: Who uses Form DHCS3100?
A: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in California use Form DHCS3100.
Q: What is a managed care differential rate?
A: A managed care differential rate is a payment rate that FQHCs and RHCs receive from managed care plans for providing services to Medi-Cal beneficiaries.
Q: Why would FQHCs/RHCs need to request a managed care differential rate?
A: FQHCs/RHCs need to request a managed care differential rate if they want to receive a higher payment rate from managed care plans for their services.
Q: What information is required in Form DHCS3100?
A: Form DHCS3100 requires information such as the FQHC/RHC name, provider number, contact information, managed care plan information, and requested managed care differential rate.
Q: Are there any supporting documents required with Form DHCS3100?
A: Yes, FQHCs/RHCs need to submit supporting documents such as cost reports, audited financial statements, and other required documentation to support their request for a managed care differential rate.
Q: Is there a deadline for submitting Form DHCS3100?
A: Yes, FQHCs/RHCs need to submit Form DHCS3100 by the specified deadline stated by DHCS.
Q: What happens after submitting Form DHCS3100?
A: After submitting Form DHCS3100, DHCS will review the request and supporting documents to determine eligibility for a managed care differential rate and notify the FQHC/RHC of their decision.
Instruction Details:
- This 2-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
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